Meal Time Effects On Psychological Stress Among Shift Workers - Essay Prowess

Meal Time Effects On Psychological Stress Among Shift Workers

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Effect Of Meal Time On Psychological Stress Among Shift Workers

Abstract

            Normally, shiftwork causes an alteration in eating patterns. This has led to workers eating all times within 24 hours period. The issue of shiftwork is a serious issue among workers and needs to be addressed. This will help in reducing the burden of shiftwork on shift workers and thus bringing a positive change. This paper examines the current evidence on the effects of meal time on phycological stress among shift workers. Systematic research was conducted with the main objective of examining the extent of phycological stress among 100 shift workers. There was also a control group of 100 day workers. The findings of this research agree with other researches and provide evidence that shift workers experience a significantly higher level of psychological stress. The findings also revealed significant relationships between stress and negative mental health outcomes among shift workers. Regression analysis determined that the major predictors of negative mental health outcomes as role conflicts and the amount of life stress. Other factors such as anger, hedonic tone, and tense arousal were also further indicated by the findings as predictors of negative mental health outcomes. Among these, anger was found to be the strongest predictor of negative mental health outcomes. To that end, this study adds additional support to the notion that shiftwork affects meal time and therefore psychological stress among shift workers. Shift work is associated with complications on the human system and this creates several phycological, psychosocial, and physiological problems and stress among shift workers.

Introduction

            Research Background

            Compared to individuals in other groups, shift workers are at higher risk of a range of psychological disorders including stress. This can be linked to the quality of the diet and irregular timing of eating. Nonetheless, other factors that affect psychological stress are likely to play a role in this. These factors include disrupted circadian rhythms, sleep debt, physical inactivity, and insufficient time for rest and revitalization. Shift working, especially ones associated with night work, can change the eating behavior of shift workers. This is caused by a diverse range of social and biological factors. Consequently, this plays a role in the development of psychological stress. For instance, shiftwork might cause conflicts between socially determined meal schedules and the biological rhythms of hunger. Viewing this psychologically, shift workers commonly experience a mismatch between their meal time routines and those of family and friends. Consequently, this may lead to a disruption of their eating habits thus leading to psychological stress.

            Problem Statement

            This paper examines the current evidence on the effects of meal time on phycological stress among shift workers. Systematic research was conducted with the main objective of examining the extent of phycological stress among 100 shift workers as an effect of meal times. The findings of this research agree with other researches and provide evidence that shift workers experience a significantly higher level of psychological stress. The findings also revealed significant relationships between stress and negative mental health outcomes among shift workers. Regression analysis determined that the major predictors of negative mental health outcomes as role conflicts and the amount of life stress. Other factors such as anger, hedonic tone, and tense arousal were also further indicated by the findings as predictors of negative mental health outcomes. Among these, anger was found to be the strongest predictor of negative mental health outcomes.

            Research Objectives

            The objectives of this research study are:

  1. To investigate and find out the comparisons in the extent of stress, mood states, and negative mental health outcomes among both shift workers.
  2. To investigate and find out the comparations in the relative contribution of stress variables in the prognostication of negative mental health outcomes in shift workers.
  3.  To investigate and find out the comparations the relative contribution of mood states in the prediction of negative mental health outcomes in shift workers.

            Significance of the Study

            This paper reviews the effect of meal times on psychological stress among shift workers. There are negative impacts associated with mealtime on the psychological stress among the shift workers. Many organizations have developed the habit of shiftwork. Currently, there is an uptick in the number of shift workers globally. Previously, there used to be few people working in the shifts. However, due to the current global economic pressure, there has been an increased engagement at work. That is why it is important to examine the effects of meal times on psychological stress among shift workers. This helps in determining how various industries such as healthcare, transport, aviation, and mining have adopted shift working and how this affects their shift workers in regards to meal times and psychological stress.

Literature Review

Modern society has moved a pattern of working twenty-four hours per day. Over the last few decades, there are increased numbers of shift workers globally. In the past years, there used to be few people working in the shifts, but the current economic pressure has increased the engagement at work (Kecklund & Axelsson, 2016. et al., 355). Globally, 24-hour service is a thriving agent for the people to work in shifts to ensure they meet the essential services’ continuous demand, urban world, business, and industrial establishments. This has made many industries such as healthcare, transport, aviation, and mining operations 24 hours a day. Wright et al. (2013, 41) currently, over 20% of the workforce engaged in the shiftwork, such as those working in the essential services like police, fire brigades, hospital employees, petrol stations, restaurants, and ambulances. Stress is a significant health threat in the modern workplace (Levecque et al., 2017, 866). In the health industry, shift work is mandatory to ensure continuous health care provision to the patients. Shiftwork involves rotating and scheduling to ensure 24-hour care. There are those in the night shift and those in the day shift, and they interchange. However, the shifts have changed the workers’ eating patterns, leading to psychological stress (Maslach & Jackson, 2013, 227). Some eat food all time, while others do not follow the three times rule a day but rather skip meals. The burden on the shift workers should be reduced to ensure their health being.

The paper reviews the impact of mealtime on psychological stress among the shift workers. Shiftwork may be advantageous to some employees for some reasons. For instance, many workers work in shifts because of some factors such as pay, schedule that allows them to go to school, childcare, or the availability of work. However, there are negative impacts associated with mealtime on the psychological stress among the shift workers (Sharma et al., 2016, 268)

Shift work is highly associated with abnormal eating behavior, which affects the health well-being of the workers. The healthcare workers work 24/7 hours to ensure quality healthcare delivery to the patients. Most health workers have been psychologically stressed due to the shifts and changes in their eating patterns. Some eat very late, some skip meals, and others do not eat at all. Bambra et al. (2008, 13) noted that most health workers in the shifts eat less and eat snacks and less balanced foods. Wright et al. (2013, 41) also noted that the workers working the night shift eat fast food than the main meal. Some of them snack more to keep them awake and maintain energy because of the heavy workload. Bercier et al. (2018, 30) also reported that the nurses who work at night eat dinner very early before leaving for work and compensating by snacking. Boubekri et al. (2014, 26) also noted that the daily intake of carbohydrates, fats, and protein is less eaten at night shift than in the day shift. Time availability and social life play a significant role in food intake during the night shift.

Stress among shift workers

Wright et al. (2013, 41) stress is expected in the workplace, and it has always been taken for granted but has negative health impacts on individuals. Stress is a state of mental strain on internal or external stimuli. Stress hinders critical thinking and problem-solving skills among the shift workers. (Centre for Studies on Human Stress, 2017), stress can be acute or chronic. Short-term stress enhances reaction and capabilities, while chronic stress is long-term and consistently leads to co-morbidities like heart diseases, depression, diabetes, and high blood pressure (Cousino & Hazen, 2013, 809).

On the other hand, acute stress has serious adverse effects on health, such as diarrhea, constipation, headaches, upset stomach, weight loss, and fatigue. More damage is caused by prolonged acute stress consisting of heart disease, hypertension, and chest pain. Chronic stress is the repeated exposure to stimuli that individuals feel anxious about, leading to crystal release over a long period. Genetic factors partially cause chronic stress, but repeated exposure to stressful stimuli leads to chronic stress. Consistent stress affects the individuals’ life and leads to alcoholic or substance abuse to release stress (Cousino & Hazen, 2013, 805). 

Ferri et al. (2016, 27) noted that increased cumulative stressful experiences are associated with drug and alcohol abuse. Frequent acute stress should also be handled positively to prevent further damage. One of the methods to release stress is physical exercise to increase self-confidence and mood enhancement. It also increases the feel-good neurotransmitters, primarily adrenaline and cortisol. Physical activity has shown positive results in reducing stress. Some of these exercises include yoga, physical fitness, and a philosophical increase of self-awareness. Ferri et al. (2016, 27) asserted that 80% of the people who practice yoga had experienced reduced stress through relaxation and exercise; stress is effectively controlled and prevents the health risks like depression, substance abuse, chest pain, and anxiety. Stress affects all ages, but it has been noted that young adults experience more stress than other ages. Also, millennials engage in unhealthy behavior because of stress and symptoms associated with stress. This group is the most affected because they are studying or working group, hence experience a lot of pressure from the workplace to achieve the set goals (Ganasegeran et al., 2014, 25).

Health professionals have been reported to be highly stressed in the whole nation. It was noted from a recent study that 69% of the healthcare workers are stress, while 17 % feel stressed due to time constraints, poor working conditions, and heavy workloads. Nurses face stress due to several roles they have to accomplish, for instance, medical administration, and ensure they have to ensure healthy outcomes for the patients (Campagna, Coppola, Finco, Galletta & Portoghese, 2014, pg. 152). 

Psychobiological factors impacting response to shift work

Circadian misalignment is highly linked to impairment performance. Evidence from various studies indicates that the shift workers are prone to sleep disturbances after being exposed to stressors (James et al., 2017, 105). Sleep reactivity results from different stressors such as personal stress, anxiety disorder, caffeine, and sleep alterations because of the shift schedule. Shift workers face a lot of challenges, which makes the work very stressful across other facets. People are who are subjected to high sleep reactivity to stress are at high risk. Evidence also indicates that genetic factors increase the chances of sleep work disorder, such as gene, which is the rhythmic gene in the central and peripheral nervous system. The gene regulates circadian rhythms through the main feedback loop (Kecklund & Axelsson, 2016, 230). 

Kecklund & Axelsson (2016, 34) the biological processes affect the psychological response to shifting work. For instance, people with repeated alleles exhibit daytime solid preference. At the same time, night shift workers have 5-repeat alleles, which is more significant in subjective sleeplessness levels with the repeat four alleles. Most shift workers carry five repeat allele which is responsible for insomnia that results from circadian misalignment. Contrary, recent studies show that shift workers are highly associated with other sleep disorders such as parasomnia, hypersomnolence, and leg movement disorder. Also, a sleep disorder may add psychological effects to shift work. The rate of comorbidities is greater among the sleep disorders and was common among the night shift workers compared to the day workers. The sleep-disordered breathing also appeared to have no difference in the rates between the two shifts.

Affects the emotional Functioning

               There is a link between sleep, circadian rhythms, and emotional functioning. There is a harmful effect of shift work on the health of the workers. Recent studies show that shift work’s global impact exhibits circadian rhythm, which results in trough occurring nocturnally. The evidence is consistent that psychological systems are involved in the impact and effective regulation. Also, results show that monoaminergic activity can be modulated through melatonin activity that is important in maintaining the central circadian pacemaker. Maslach &Jackson (2013, 227) show that melatonin agonist administration results in a direct or indirect increase in monoaminergic activity. The increased monoaminergic activity blocks the melatonin receptor antagonist. This harms mood and mood regulation. In addition, interference of the circadian pacemaker leads to dysregulation in the moods. The monoaminergic systems are responsible for mood arousal, reward, and motivation, which have a critical consequence on mental health. The shift workers who operate in opposition to their pacemaker spend their time when the monoaminergic system is downregulated, resulting in reduced arousal, reward-seeking, and motivation (Maslach &Jackson, 2013, 227).

            A qualitative study among the night shift nurses shows that depression is shared among the night shift workers. However, in another study, Robins et al. (2012, 117) note that nurses on a rotating shift schedule had moderate psychiatric symptoms compared to those in the day shift. The recent systematic review also suggests that accumulating evidence for the shift work is a risk of depression is mixed with the results which increased the risk while others do not. The risk for depression in shift work is specific to maladjustment to shift work, and not all of them are engaged in the shift work experience, which is a significant impairment. Individual transition to shift work found that depression and anxiety a year after the shift work as enhanced by the development of shift work sleep disorder (Maslach &Jackson, 2013, 228).

Stress among the shift nurses 

The nursing fraternity faces stress due to the pressure at work. They have to work in shifts to ensure continuous health care services are delivered to the patients. Nurse stress leads to burnout, which means physical, mental as well as emotional exhaustion. The healthcare workers undergo shifts that interfere with their regular schedules, such as eating, sleeping, and socializing; hence, they have other health complications such as anxiety, depression, and food-related food-related diseases like diabetes Bambra al. (2008, 776). Most nurses do not get enough sleep because they have to continue with their routine at home even after they have come from their night shift. It is dangerous not only to the nurses but also to the patients because they become disengaged and do not deliver quality services.

 James et al. (2017, 206) noted that there is no adequate nurse staff, so most nurses are engaged at work, and the shifts are frequent. The nurses are left with a significant number of patients to handle, and therefore they lack time to rest and have their meals. The nurses are posed with so much to handle, which poses a substantial risk to the patients. Maniam & Morris (2012, 35) explained that the patients’ dangers due to understaffed health workers lead to medical error because the nurses are left hungry, worn out, and exhausted. 

Maniam & Morris (2012, 35) asserted that nurses’ stress rates and mental fatigue are because of inadequate nurses, which leads to poor health results. Medical errors and poor quality delivery have caused nursing mistakes. Continued inadequacy results in nurse burnout leading to nursing turnover hence make the situation worse. A reduced number of nurses increases stress among the nurses because of the responsibility they have to carry. They have to care for more patients than expected and work for more hours, which changes their eating patterns, resulting in other health effects (Bercier & Maynard, 2015, 78). Increased turnover rate is due to dissatisfaction at the job; their inability to work for long hours has stressed them. The health industry should employ more nurses so that the number of patients per nurse is adequate to give them enough time to rest, sleep and eat healthy (Bercier & Maynard, 2015, 78).

            Effect of shifts to the psychological functioning Cognitive Functioning

Shift workers often suffer from the effects of circadian misalignment as well as sleep deprivation. It is then surprising where shift workers are vulnerable to a deficit in the cognitive domain (Simons & Buitendach, 2013, 10).  The deficit in the domain is relevant to occupational performance because of the effects of productivity, public and employee safety (Robins et al., 2016, 123). Despite its significance, the study delineates some cognitive vulnerabilities, which are associated with shift work. Most research has focused on the vigilance determined by the psychomotor caution task. Many studies have shown the increased attention lapses and reaction time in the biological night (Virgili, 2015, 335).

The most recent studies have focused on cognitive functioning, and the findings indicate that not all types of cognitive activities are impacted. For instance, a crossover study by Cornelio (2017, 78) investigated the nurses working in the day and the night shifts. The results indicated little difference in the global cognitive impairment, but the varying results were noted in different cognitive processes. The results were consistent with the existing research where the most significant effect was found in vigilance for errors. A more significant effect was found in the inhibition response. A slight effect was noted in the mental speed, which was measured among the 25 mathematical problems. This implies that the industries and health workers who work in shifts do a disparate cognitive function, especially where time and vigilance are difficult. The long-distance drivers are affected by cognitive impairments related to shifting work (Cornelio, 2017, 89).

Emerging studies also suggest that some cognitive components may differently be associated with psychophysiology with symptom presentation. Hulsegge et al. (2020, 144) split cognitive flexibility into various categories reacting to new stimuli versus suppressing the old stimuli. The findings indicated that attention flexibility for the new stimuli was strongly related to the circadian phase, unlike sleepless symptoms. Also, the insomnia symptoms versus sleeplessness were differently liked to specific deficits. The shift workers with insomnia showed difficulties suppressing the previous stimulus that was irrelevant to the task. The sleepy shift workers showed difficulties in repeating the previous tasks. The results were consistent with the previous studies, which indicated that the shift workers with insomnia had increased cortical activity. They were less attentive to the previous stimuli in their working environment (Hulsegge et al., 2020, 145).

On the other hand, specific cognitive flexibility components had a differential effect on task performance (Robins et al., 2016, 117). The shift workers with difficulties in the attention flexibility for the new stimuli took longer to finish the tasks ahead of them, and some needed two more times to complete the task. This had a significant implication for efficiency and productivity. On the contrary, the shift workers showed difficulties with suppressing the task, which was irrelevant to the stimuli, indicating reduced accuracy, especially with more occurrences of the preservative errors. This has important implications for productivity and safety (Sominsky & Spencer, 2014, 435).

Virgili (2015, 82) examined the chronic exposure to the shift workers on cognitive functioning and reversibility of the effects. The general study indicated that exposure to shift work is linked to a 1-6 pint decrease in cognitive performance on a scale of 0-100. The researcher assumed the decline of the cognitive functioning for more than 30 years for the 32-year-old individuals; the magnitude of the impact of the exposure to the shift work was equivalent to a 4.3-year age-related decline. Further analysis was done to compare the exposure duration. It was stated that exposure for more than ten years was linked to increased global declines in cognitive functioning as opposed to those of less than ten years exposure (Virgili, 2015, 95). In particular, those workers with over ten year’s exposure indicated a 2.5-point decrease compared to those without exposure. Those with ten years or below exposure to shift work exhibited a 0.9-point decrease. This analysis was done to compare cognitive deficits’ effects based on the transition away from shift work. The findings showed that those exposed within five years to shiftwork continued to have a reduced cognitive functioning while those with more than five years exposure to shift work had no difference compared with those with no shiftwork exposure (Virgili, 2015, 112).

 Lack of enough sleep (sleep disorder)

Wang (2020, 330) shift disorder has been highly associated with shift workers. Even though the employees seem to adapt very fast to the typical work schedules, many have experienced some functional impairment. About 10-20% of the shift workers were associated with sleep disorder, which was characterized by insomnia or excessive sleep during wakeful hours. They were also associated with reduced total sleep time. The sleep disorder is linked to the work schedule, which overlaps with the usual sleep time to begin their shifts (Touitou et al., 2017, 106). There should be a three-month break to ensure no disruption of circadian disruption because of the work schedule. The night shift schedule should have many shifts workers so that the rotation is not frequent. Delay in the circadian rhythms results in circadian misalignment. Night shift workers attempt to perform their duties when their body needs to sleep and sleep after the shift when they should be awake interferes with the body’s biological functioning (Simons & Buitendach, 2013, 12).

Marina Fischer et al. (2006, 45) conducted a study to investigate night-shift workers’ effects on the quality of sleep and stress. In the study, 60 health workers who work on night shifts have investigated the Netherlands. Most of the participants complained of sleep deficiency and health complaints. Maslach & Jackson (2013, 67)also conducted a study on the United States’ psychiatric hospital. He found out that most night shift workers had more difficulties initiating sleep than those in the daytime shift. He also noted those night shifters ate many snacks at night since they were always awake while those who worked during the day at a lot in the evening slept soundly. The eating patterns in both groups were interrupted, resulting in other health conditions and stress. Night shifts cause sleep disturbance, and they were likely to sleep during work and ask for sick leaves (Boubekri et al.,2014,  606)

In a different study Sharma

et al. (2016, 28) also noted that most nurses lack sleep due to the night shift, which affects their work, slow physical and mental reactions, and increases medical errors. A stressed nurse from shifts has been associated with impaired memory and reduced motivation. This affects their feeding habits; having meals regularly is very important to the circadian rhythms, influencing human metabolism (Ferri et al., 2016, 201). Shifts disrupt sleep, eating, social life, wakefulness, and these affect gastrointestinal diseases. Social factors such as lifestyle, eating habits, working conditions, and age may contribute to ill health in the night shift workers. The commonly identified issues associated with night-shift workers include insomnia and gastrointestinal issues, including diarrhea, loss of appetite, abdominal pain, reproductive and cardiovascular problems Cousino &  Hazen, ( 2013, 809). Endocrine reactions may less suitable for food intake, significantly at night hence increases obesity and cardiovascular diseases.

Touitou et al. (2017, 98) conducted a longitudinal study from varied age cohorts like period and distinguished between the shift workers. The groups were divided into over ten yea shift workers, those who have never worked in shifts and those who have worked in less than ten years. The study aimed to investigate how to shift working affects sleep and determines the shift workers’ poor sleep persistence. The previous comparison was made on the current and former shift workers and those who had never worked in shifts. The results indicated that the shift workers experienced many sleeping challenges (Touitou et al., 2017, 96). It also indicated that the first-time shift workers had more difficulty than those who had worked for longer years. There was chronic fatigue that reduced their morale to work in shifts, and they were prompted to quit. The former shift workers in the younger years between 32 to 42 years reported having had sleep issues more than those who had never worked in shifts. Most poor sleepers were shift workers or were disrupted from sleep for shift (Touitou et al., 2017, 99).

            Poor eating patterns 

Simons & Buitendach (2013, 78) shift work is good in timing food consumption, but the eating pattern is affected mainly for those in the night shifts than their counterpart day shift workers. Poor eating habits are unhealthy for the workers. This relationship of food and shifts was noted in many studies; for instance, Ferri et al. ( 2016, 206) conducted a study to investigate the effects of the night shift on food intake and the eating habits among 36 workers United States. The findings indicated that night shift workers did not eat as much as the day shift workers, but they eat many snacks and foods in small amounts of food. 

Vijayalaxmi et al. (2014, 177) conducted a prospective study including 100 employees of Father Muller Medical College on the shift employees’ heath pattern and compared it with the day shift workers. The participants were divided into two groups of 50 members. It was labeled group A for the night shift and group B for the day shift, a control group. The study lasted for over two months. Data was collected using the health-based questionnaires, which were divided into six parts that included food habits, physical attributes, psychological well-being, working conditions, and lifestyle Vijayalaxmi et al., (2014, 177). The permanent day employees and shift employees from various job ranks were selected, including doctors, nurses, lab technicians, house surgeons, and ward house cleaners. Those who were unwilling to fill the questionnaires and those who filled half were excluded from the study. The researcher used Chi-Square to investigate various factors like the working environment and eating habits with shifts. Among the participants, 39% were doctors, 18% were lab technicians, 21% were nurses, while 27% were non-clinical workers such as secretaries, security guards, and word workers. The night shift workers had low health scores of 35.0 compared to the day workers who had 39.5. The day workers’ psychological health scores were 12.5, while that of the night shift workers was 10.7. Also, the lifestyle factors such as inadequate sleep, lack of exercise, skipping meals, and irregular eating habits had a significant relationship with the shift. They contributed negatively to the health of the workers Vijayalaxmi et al., (2014, 177). 

Souza et al. (2019, 15) conducted a systematic study to investigate the relationship between shift work and eating habits. The researchers used PubMed, Embase, Web of Science, and Scopus to search for the relevant articles. Data were obtained from 33 observational studies, which met the criteria of inclusion. Extraction of data was accomplished using a standardized form.

The findings indicated a significant relationship between shifts and food eating habits (Souza et al., 2019, 15). The shift workers showed changes in the eating time; some were skipping meals and consuming more food.  The results also indicated high consumption of unhealthy foods like saturated fats, soft drinks, and other snacks. It was concluded that shift workers eating habits were ill for their lives. It was noted that most of the workers, especially in the hospitals, ate poorly because of the working condition, and most of the them-skipped meals and relied on snacks.  The longitudinal studies, which investigated the effects, shift duration, workday on seep and food patterns, indicated a significant relationship that the more the workers spend in the workplace, the more they lost appetite for food and the more they became stressed (Souza et al., 2019, 15).

Bonham et al. (2016, 1008) conducted a systematic review to investigate whether the 24-hour energy of the shift workers differed from those working in the daytime. The articles compared the night shift workers’ energy intake and those in the daytime shifts and noted a difference in the energy consumption between the two groups. Bonham et al. (2016, 1008) stated that shift working is dangerous as it is associated with chronic diseases such as cardiovascular, diabetes two, and obesity. There were 10 300 workers and 4720 shifts identified from 12 studies that used qualitative and meta-analysis. The standardized mean used was 95% in the energy consumption among the changes. The results indicated that the intakes were different from the transitions. It was noted that energy intake was no different from daytime workers and night shift but suggested that other factors like circadian misalignment, food choice, duration of energy metabolism, and meal patterns are responsible for the health issues such as obesity the shift workers.

Hemiö et al. (2015, 516) conducted a study to investigate the food and nutrition intake differences among the shift working groups. One thousand four hundred seventy-eight workers of the airline were divided into three groups. The groups included 608-day workers, 541 shift workers without flights, and 329 shift workers in-flight. The measurements and lab tests were taken; questionnaires were used to collect data. Food and nutrient intake were filed in the questionnaires. The researchers noted that over 20% of European workers work in shifts and have increased chronic diseases. A healthy lifestyle is recommended because it is the cause of stress and health issues. The results indicated that change working men were less likely to eat vegetables and fruits daily, but they snacked more, whereas in-flight workers consumed more fruits and vegetables. Hemiö et al. (2015, 516) noted that many women workers consumed saturated fats than the shift men workers. It was concluded that shift work and the working conditions were significantly related to the workers’ dietary patterns. The increased chronic diseases among the shift workers were associated with lifestyle and eating habits.

Sominsky & Spencer (2014, 78) surveyed 142 nursing students in a different study; among them were 20-21 years. Out of 142, 129 were female, and the rest were male. Their weight measurement was taken between 100-274 pounds. The 55 surveyors stated that nursing students have stress and poor dietary habits. For instance, some gained weight during the nursing internship programs, and the weight gain ranged between 2-50 pounds. However, 33 students lost weight between 2-30 pounds while 54 students remained the same. No weight difference was noted between male and female students. Most of the students in the practices said that they skipped meals to finish up with their work. Only 61 out of the participants claimed to have had three meals per day. Sixty-eight of them claimed to have skipped at least one meal. The majority of the nurses claimed to have missed meals due to work pressure.

Thirty-one of the participants stated that they skipped meals during the nursing programs because of the work schedule. Eighty-six of the participants claimed that their meals were entirely carbohydrates, whereas eight said they ate fast food. It was noted that there was a correlation between work shifts, stress, and eating patterns. Most of the shift students claimed to be stressed, and their anxiety was related to their dietary habits (Sominsky & Spencer, 2014, 89)

Negative Health impacts

Most studies on the effects of shift on eating habits have indicated negative health impacts on the workers. For instance, Touitou et al. (2017, 70) investigated the psychological stress based on poor eating habits among the shift workers, indicating that the night shift workers had low job satisfaction than the day shift workers. There was a relationship between stress, poor eating patterns, and shifts. Verma et al. (2018, 109) also compared the relationship between changes and anxiety among the 3078-day workers and 1884 shift workers. They noted high stress among night shift workers compared to the day shift workers. Virgili et al. (2015, 317) indicated that infections were prevalent among the working employees in different shits in the Netherlands. The researcher pointed out that the night shift workers were highly diagnosed with flu, gastroenteritis, and common cold instead of workers. Also, there was a difference in the health behavior, fatigue, stress, and sleep disorder between the two shifts. Vogel et al. (2012, 1011) examined 1600 employees in the industry, banks, and schools on the prevalence of gastric ulcers, and it was noted that 2.3 % of shift workers had gastric ulcers compared to the 1.03-day workers.

In another cross-sectional survey of 340 factory workers in the United States by Cornelio (2017, 34) aimed to investigate the relationship between the work schedule and gastrointestinal symptoms, diagnosis, and medications. The findings demonstrated that night workers were diagnosed with gastrointestinal disturbances. In a different study Hulsegge, et al. (2020, 146) investigated the effects of shift work on workers’ health. Stress, insomnia, and psychological issues on the shift workers were evacuated. There were 850-night workers and 550-day workers in the manufacturing plant in Korea. The findings demonstrated that the night shift workers suffered from psychological and physical distress compared to the day shift workers. Most of the night shift workers were diagnosed with insomnia and health distress. 

            A cohort study examined the impacts of the shift work on dietary intake base on the food consumption patterns. The study was conducted among commuter workers; 44 were daytime workers, while 93 were night shift workers who changed shifts among themselves (Sharma et al., 2016, 134). Forty-seven were engaged in the early shift work, while 46 were engaged in the late time shifts. The age of daytime was higher than that of the night shift. There was no significant difference between the body weight and BMI between the two groups. The energy intakes were also noted. The results indicated no difference between the two groups; the diet consumption investigated included proteins, calcium, iron, fat, and carbohydrates of the day workers and night workers were checked(Sharma et al., 2016, 134). The photographic methods were used for self-registered food consumption. The commencement time and percentage distribution of the meals and snacks, energy, and nutrient intakes of the three groups were measured on workdays. The findings indicated that the shift workers, especially those who worked partially late, consumed little energy and nutrients than the daytime workers. The results implied that Shift workers’ diet status was poor, and their eating patterns were poor compared to the daytime workers (Sharma et al., 2016, 134).

On the contrary, Kecklund & Axelsson  (2016, 34) argued that the rotational three-shift workers did not affect the workers’ nutrition quality. A study of 16 healthy male shift workers aged 34 years was selected to participate in the cross-section study. They were interviewed on their perception of the 24-hour consumption on the morning, afternoon, and night shifts. The twelve-hour was also investigated and the day of as well. The findings indicated that intake of energy and nutrients was well done during working hours. Also, there was no significant difference among the shifts of working.  In a similar study, Levecque et al. (2018, 879) examined the quality of food consumed at night and during the day among the shift workers. 176 nurses worked on night shifts and 70 nurses worked only during the day. The participants’ mean age was 34 years, and their work experienced was from 1-30 years. It was concluded that the night shift nurses consumed more cold meals and drank more coffee and snacks than the day shift workers.

McFadden et al. (2015, 19) conducted a longitudinal study among the nurses, and the cohort consisted of 469 female nurses who worked in the acute care unit in the public hospitals in France. The study aimed to investigate the prevalence of overweight and weight gain because of the night shift. The demographic features included exposure to the night work, parity, sports activities, age, smoking, and eating patterns McFadden et al., (2015, 19). The patients filled the questionnaires. The physicians to check the BMI measured the weight and height; the results indicated much exposure to night shift, which resulted in weight gain. Some of the factors that led to weight gain were that they did not eat balanced, died, did not get enough sleep, they could not find time for exercise because of the tight schedule (McFadden et al., 2015, 19).

In a cross-sectional study, Robins et al. (2012, 89) investigated the effects of age and shift work exposure on the workers’ psychological well-being.  The interactions were between the workers who worked at night and during the day. Data was collected from the personnel working in the oil gas company in the United Kingdom. One thousand five hundred male participants worked in the gas company, and 787 worked in the day while the rest worked in the night rotation shifts.

They were asked about their demographic factors such as height, smoking habits, weight, shift, and years of exposure to the transitions; the day-night shift workers were associated with increased body mass index BMI, which varied from the age and years of exposure. Most of them stated that they snaked a lot and had most of their time working, and lacked enough time to eat, exercise, or sleep (Robins et al., 2012, 89).

In a cross-sectional study, Verma et al. (2018, 66) investigated the effects of shift work on metabolic syndrome, including obesity, high triglycerides, and hypertension because of poor eating patterns. There were 27,840 participants from Vasterbotten in Sweden.  The sample consisted of the night and day shift workers aged between 30 to 60 years. Data was collected by taking blood samples and completing questionnaires. The results indicated that the night shift workers’ prevalence of obesity and other health-related diseases were higher in the night-time workers than the day shift workers. This was because of the work pressure, lack of sleep, stress, and poor eating patterns.

Virgili (2015 et al., 327) unhealthy-eating patterns are common among the shift workers. The shifts affect their sleeping quality and appetite to eat a balanced diet at the required time. Work schedules have negatively impacted the sleep pattern of people working in shifts; most of them suffer from insomnia and stress. Poor quality sleep increase appetite in some people, so they end up snacking all night and get obese (Sominsky & Spencer, 2014, 12).   In an experiment on shift work and strained sleep patterns, the researchers noted that sleep limitation increased snacking, and most of them choose sugary food such as tea, biscuits, cakes, and sweets. Therefore, stress and shifts are related and influence poor eating patterns, especially on energy-giving foods, like starch (Simons & Buitendach, 2013, 12). Added sugar adds calories, which do not have any nutritional value to the body. The overeating of sugary foods and sweetened beverages adds more calories, which increases health issues associated with overweight like obesity. Virgili (2015, 69) suggested that more sugar intake is very harmful to the body. Excess sugar dysregulates appetite and causes high blood pressure, diabetes, and steatohepatitis. The health risks due to increased sugar consumption result in increased chances of type 2 diabetes, cardiovascular, hypertension, cancer, osteoarthritis, and hyperlipidemia conditions. Moreover, overweight and obesity have been associated with the shift workers, which also reduce their productivity.

Cornelio (2017, 52) shift workers in health organizations have been associated with weight gain because of their poor eating behavior.  Though some researchers have found contradictory results, an investigation on the BMI and eating behavior indicated that stress was associated with weight gain. There was no relationship between shifts and weight gain.  In a different study in Massachusetts, Cornelio (2017, 52) examined the nurses’ job conditions, lifestyle, and stress. The findings showed that 80% of the workers were stressed from the job, which increased their BMI because pressure increased their appetite, especially on sweet foods. Stress increased eating habits, but those who had job satisfaction did have healthy eating habits. Most of the stressed nurses reported having eaten more vegetables and fruits than the less-stressed colleagues.  In a different cross-sectional study, which was analyzed from the longitudinal nurse work, the researcher noted that there was no link between stress and BMI. The study consisted of female nurses in nursing for at least a year and excluded men. It was not easy to tell whether stress affected men‘s eating habits, but it affected women. The results indicated that work-related stress was a factor from Robins et al. (2012, 87) studies. 

The interviews were conducted among 27 night shift home-based nurses in Sweden on the situations that contributed to the shift workers’ diet and stress. The participants stated that they would have an appetite to eat when they felt hungry and stressed, and they ate unhealthy food. The researchers noted the authentic experiences among the nurses and investigated the variability of their responses. He categorized them into a factor that led to poor eating habits and coping from stress both at home and at work. The research also used semi-structured questions among the nurses but did not observe when collecting data. 

In a different study, Hulsegge et al. (2018, 147) examined the relationship between work-related stress and BMI among the nurses who work in shifts. Forty-five thousand eight hundred employees participated in the study. The researchers measured their stress rate as high job demand and low control using questionnaires. They also measured effort and reward among the employees that would motivate them and reduce stress. Six thousand five hundred of the participants were nurses, and the researchers noted a significant relationship between job strain and stress among the nurses. They also indicated that motivation through rewards reduced stress and increased job satisfaction. There was a relationship between stress, job demand, and BMI, and the nurses said they skipped meals to meet the target and deliver care for the patients. Stress is a poor predictor of general health Wang et al., (2020, 89). It was also noted that women were in high demand, but there were low control jobs, which had social support. There was high demand at the job, and there was no time for exercise. Stress was connected to the working conditions. Stress affects the health delivery of the workers. The people who worked in shifts, such as drivers, did not gain weight, yet it has been highly noted among the nurses that it adds weight. Researchers, some other factors can lead to stress. For instance, some personal characteristics can result in stress. It depends on how individuals approach matters that can bring stress in their lives. Response to the stressors varies among individuals, and the coping strategies differ too. Some guidance and counseling can reduce stress. There were conflicting results on how people approach stressors, and it was noted that personal perception defines what driving conditions can lead to stressful situations. Weight gain was also another factor that was considered confidential. There should be discipline in the eating behavior after having the knowledge those poor eating habits affects our body health-wise (Sominsky & Spencer, 2014, 28)

            Shift work stress 

Shift-related work has been associated with stress, weight gain, poor eating habits, and obesity. In a cross-sectional study, Souza et al., (2018, 123) investigated the participants from 85 hospitals who were selected and investigated the relationship between shifts and weight gain. They were divided between late shift and early shift. It was noted from the results that there was no significant relationship between weight gain and time for transitions. In a different study Souza, et al. (2019, 345) noted that the nurses’ reporting hours were associated with obesity, and the night shift nurses were associated with obesity compared to the day shift workers. Their eating patterns were affected because of time and pressure to deal with emergencies. They could not get time to eat a balanced diet. Most of the food they ate was snacks or fast-moving foods. Their food was also cold compared to those who ate at home. The shift workers had eating behavior issues; most of them lacked appetite, and some overate to recover what they had not eaten. Some were forced to eat very fast to go back to work, unlike the day workers. Also, working hours affect the workers; those who worked long hours complained to be emotionally exhausted than those who worked short hours. 

Wright et al., (2013, 41) the nurses in the acute units had negative emotions and most of them would overeat than those who worked during the day. The researchers noted that the shift duties in the night working hours affected workers psychologically more than the daytime workers. They did not find the difference in the duration of the shifts. The workers complained of disturbance due to the negative influences, they lacked diet, time, and exercise because they left job while very exhausted. The female workers were highly affected because they have to go back home and start over again with family chores Wright et al., (2013, 44) Old age, gender, and individual factors determined the stress effects of the shift workers. Some people are stress-tolerant and have good coping strategies. Study shows that the young, male gender with a low score of languidity, neurotics, and boringness. While they have high scores of extraversion, internal locus of control and flexibility were associated with high shift work tolerance. Job control depended on the health status and low level of distress. Ages were associated with reduced flexibility and adjustment of circadian and sleep Souza, et al., (2019, 114)

            Psychosocial Functioning

Shift workers have been diagnosed with the psychosocial disorder. There is a link between depression and work which accounts for psychosocial work-related conditions especially people who work outside the health industry like transport, petrol stations, police among others. In the most recent study, Touitou et al., (2017, 98) noted that job satisfaction was lower in the shift workers especially nurses than the day shift workers. In another study, Virgili, (2015, 326) also noted that the shift workers reported having less support from the administrators and leaders hence they become demotivated. It was also noted that the employee well-being in the workplace was inaccessible to the shift workers because of the work schedules resulting in aggressiveness and conflicts. However, there are reports on the work the support from the administrators and leaders that enhanced shared challenges, which relieved the burdens for the shift workers. Apart from the work setting, the shift workers are at risk of social isolation which is likely to results in irregular or night work schedules. The most recent study indicated that the rates of the intimate partnership were lower among the shift workers compared to the daytime workers. It was noted that 20% of the shift workers were single because they have limited social life. (Vijayalaxmi et al., 2014, 178). In another study, Sominsky & Spencer (2014, et al., 434) also noted that 31% of evening workers and 27% of the day workers were socially isolated. The rate of social isolation was also reported at 10% in the large community sample. The results suggested that social isolation is higher among the shift workers mostly the night shift workers as opposed to the day shift workers. Increased social isolation enhances sleep difficulties among the single shift workers compared to the partnered shift workers.

(Vijayalaxmi et al., (2014, 178) family plays a key role in the social well-being of the shift workers. Health perception of the shift work nurses indicated that the family helps to boost the moods of the employees. Sometimes family stress increased pressure and stress to the shift workers. The participants with families also exhibited fatigue, obesity, reduced social life, diabetes, and medical difficulties. Shift parenting gas resulted in more stress among the nurses; this also affects the children since they spend less time with their parents (Souza 2019, 17). They cannot compensate with the day off since the children have to continue with workday schedules such as schooling among others. Shift parents do not spend time with their children and play the parental activities together with their children such as reading, playing, sharing meals, and other social activities. In the sex-couples, it was also noted that most of them were engaged in the shift workers and led to stress and divorce (Vijayalaxmi et al., 2014, 175).

Cornelio, (2017, 97) social engagement has negatively affected the shift workers. The social participation In the United Kingdom shows that shift workers were less socially engaged as opposed to the non-shift workers. The social participation included general engagement with support, helping others volunteering, artistic events, cultural engagement, civic engagement, and religious activities. On the other hand, the daily workers were dedicated to the 8 hours’ work per day and participated in the social activities. The shift workers worked close to 6 hours per week resulting in reduced social participation, which was associated with the weekend work. The social participation was during the weekends, which was time out of the work activities. Cornelio, (2017, 107) noted that the time and activities of the nurses indicated that 52 % of the night shift workers and 27% of evening workers stated that they rarely engage in social activities because they do not have spare time.  This has accounted for the reduced engagement among the shift workers as opposed to the daily workers. Social engagement is healthy for the mental well-being of people. It leads to mood disturbance because of the reduced social engagement to ease their brains and relief stress.

Summary

From the above review, the following was noted that most of the shift workers changed their eating patterns, which increased stress and other psychological conditions. Night shift workers found less sleep than the day shift workers and those who have never worked in shifts. This highly influenced their health well-being (Sharma et al., 2016, 227). The shift workers also felt disrupted more than the daytime workers did. Many workers in the night shift lacked time for exercise while those in the dayshift got time to exercise and maintain their good eating habits hence kept fit while the night shift workers added weight and suffered weight and food-related diseases. The daytime shift workers went to the gyms and exercised yoga, which refreshed their minds and relieved them from stress. Walking was the commonly preferred exercise followed by yoga and gym (McFadden, et al 2015, 1000).

In addition, meal skipping was common among the shift workers; over 50 % skipped meals to meet the demands of the job (Bonham, et al., 2016, 1002). Most of them skipped breakfast and dinner then lunchtime, some snacked and ate energy drinks more than the daytime shift workers eat. Most day employees ate homemade food while shifting workers consumed foods from the cafeteria and there were frequent interviews on snacking. Among them, 52 % of the employees in shifts especially night shifts snacked all through the time of working (Bonham, et al., 2016, 1002).  The night shift employees also used more coffee compared to the daytime employees. They believed that coffee would keep them awake the whole night. The many employees in the shift experienced stress, anger, and depression than the daytime employees. The psychological score mean was greater in the day workers compared to the shift workers (Bonham, et al., 2016, 1002).

Wright et al., (2018, 14) noted that the employees in the healthcare organizations had a gastrointestinal, common cold, and headache conditions more than those in the daily work. The shift workers had a low score in general health compared to the day workers. The common problem among the shift employees was back pain and headache. Some experienced abdominal, indigestion, lack of appetite, heart palpitation, and reduced reproductive issues. It was also noted that most shift workers have the psychosocial disorder because they do not have spare time for social life. They should spare some time to meet friends and participate in social functions to relieve them from stress (Wright et al., 2018, 14).

Recommendations

The modern world has changed into a technological and industrial world that requires people to work 24 hours to achieve social, economic, and political goals (Levecque et al., 2017, 64). Shift work is vital ensuring continuity of eservices in the essential services, and residential services. Night shift is most frequent among healthcare workers. The shifts have negative impacts on the workers, for instance, it results in the disruption of circadian rhythms that cause interruptions in sleep and other biological functions. This negative effect of the shifts affects the psychological and physical well-being of individuals (McFadden et al., 2015). The registered nurses have encountered stress due to poor eating patterns resulting from shifts. Job satisfaction is one of the factors that reduce stress among the nurses, however, most of them have been exposed to poor working conditions, and they have to work for many hours due to inadequate nurse staff (Cousino & Hazen, 2013). Shifts have interfered with the quality of sleep leading to insomnia, psychological and cardiovascular health conditions. The frequency of the shifts results in fatigue and burnout, hence increase rates of attrition. The nurses require a high level of attention to carry out their responsibilities but the working conditions have optimized the quality by making them work 24 hours (Bercier & Maynard, 2015, 85).

Ergonomic criteria should be implemented to reduce the adverse effects of the shift among workers, especially in health care organizations. There is a positive correlation between the quick returns and sleeplessness, fatigue, and shift disorder. There must be enough breaks between shifts so that the employees could get time to relax and socialize with people. Cousino & Hazen, (2013, 803) the shift worker’s well-being should be ensured so that the adverse effects are reduced and job satisfaction is attained. The workers should be increased and more shifts created so that people do not have to stay on long shifts. There should be breaks in between for their time to eat so that they do not develop health issues associated with psychological stress as well as social maladjustment (Boubekri, et al., 2014, 120).

Recommendations for employees

The shift employees should avoid caffeine and alcohol before they go to sleep because it has health effects on the body. They should also avoid taking large meals at once to compensate for the skipped meals instead they should eat in small amounts at the required schedule. The employees should avoid energy food intake in the night shifts since it adds more calories, which have no nutritional value to the body. All workers should take breakfast before starting the day and after the night shift to avoid being awakened because of hunger. There should be family and friends to support the social well-being of the workers to prevent psychosocial disorder. They should ensure they find a quiet and peaceful place to sleep after shifts of work. Finally, the shift employees should create some times for social life and exercise to reduce pilling calories that lead to diabetes and obesity.

In addition, the place they sleep should have good air conditioning, eye masks, a telephone answering machine, and foam earplugs, and good curtains to improve sleep. Moreover, they should have time for relaxation before they go to bed to facilitate good and healthy sleep. These can include reading, breathing exercises, and muscle relaxation, methods like massage. Sleep is a schedule, which established a routine and facilitates sleeping during the day even for the night shifters. The workers should avoid strenuous exercises before they go to sleep because it interferes with the body’s metabolism and that can make sleeping difficult. Those who cannot seep can read a book or listen to soothing music to relax the mind. The shift workers at around 40 years find the work difficult and decide to quit their employers should change shifts for them so that they have enough time to relax since they still need that job for social and economic development.

Recommendations to the employers

The employers are responsible for the well-being of the workers if they need productivity and performance. They should design schedules that are healthy friendly and allow the employees to have ample time to relax between shifts, sleep, and meals to avoid returns. The most demanding work should be done in the morning when the workers are fresh and alert than working in the evening, which results in errors because of fatigue and stress. Employers should also create short shift schedules and have more frequent breaks to allow refreshment and reduce fatigue. the breaks allow them to get time to eat and have enough rest as well have gyms and exercise places in the working places where they can exercise while free to reduce stress and fatigue. The work schedule shifts should not go more than five hours in a row and the workplace should be brightly lit. More employees should be employed to reduce shortage and heavy workload, especially in medical organizations as it leads to stress, burnout, and attrition. It also results in poor service delivery, which has negative results for the patients.

The night shift workers should be reduced to allow the employees to have some rest or sleep in between. The employees can be scheduled to work one or two nights in a row and avoid giving them excess overtime. The employees should be trained about steps that they can apply to reduce the negative effects of the shifts and stress coping strategies. The shifts can be rotated morning, afternoon, and night to allow more space and time for employees. The shifts can start at 6.a.m to avoid being late and give at least 48 hours between shifts change to allow them to adjust their bodies for the health well-being. Employees should avoid splitting shifts and giving excessive work that will take them for more than 12 hours.

The places of work should have good facilities where the employees can find time to rest and exercise to refresh their mind and body before and after the shift. For instance, the hospitals should have places for the employees to take a nap before they go home. Employers should identify the employees who have a sleep disorders and help to treat them. The sleep disorder victims should have regular checks since it results in health issues.  The schedules should also be designed in a way that allows for lengthy breaks, starts, and finishes that are convenient for all employees.  Employers can make frequent health checks to the employees beyond 40 years and those with underlying heath issues to ensure they are comfortable. Those with underlying conditions and sleep disorders can be transferred to the daytime shifts and their time for work reduced to allow them to get time to go home early and rest. More employees should be employed to reduce shortage and workload pressure that force employees to work long hours and strain themselves.

Research Methodology and Design

            This research examined 100 shift workers and 100 day workers in a company. The sample size for both groups of workers was restricted to one hundred because it was large enough to allow statistical analyses of the studied variables. All the workers were a mixture of both males and females. Some were married and others were not married. The following criteria were to be met to be considered a qualified participant:

  1.  Working in shifts and has always been a shift worker. This information was gathered from the company’s records on work schedules. From the data collected at that time, there was a three-shift system in the company: morning, evening, and night shifts. The morning shift started at 8 AM and ended at 4 PM; The evening shift started at 4 PM and ended at midnight, and the night shift started at midnight and ended at 8 AM.
  2.  Be a permanent day worker who has never worked on the shift working system. The information on factors such as age, sex, marital status, educational qualifications, and length of service were collected for each participant of the study. The mean age of the one hundred shift workers was 45.15 years and the SD was 6.22 years. In the same way, the mean age of the one hundred day workers was 44.52 years and the SD was 7.67 years.

            By the same token, the mean length of service of the 100 shift workers was 19.54 years and the SD was 5.60 years. For the day workers, the mean length of service was 19.21 years and the SD was 7.58 years. The day and shift workers were matched with regard to important demographic factors such as age, sex, and length of service. The whole data was collected using a standard questionnaire based on the response by the workers in the company. The effect of the order of exposure for the different shift types was controlled because the questionnaires were administered in the same shift to all the participants. Before administering the questionnaires, the nature and purpose of the planned proposed research were explained to each worker. Furthermore, the questionnaires were administered either individually or in small groups. Either way, all the individual data for each worker was kept confidential. The data were collected during work hours. However, it was done away from the immediate workplace.

            Measures

            This research measured a number of variables in order to get the required information. The following are the measures of this study.

  1. Occupational Stress Index (OSI)

            The occupational stress index entails the total scores of role overload (number of items is 6) and role conflict (number of items is 5), role ambiguity (number of items is 4). The workers rated the items on a 10-point rating scale. This was from strongly disagree to strongly agree. A higher scores showed a higher level of stress.

  1. Presumptive Stressful Life Events scale (PSLE)

The presumptive stressful life events scale is a scale of 51 life events. In the PSLE scale, the workers were required to report the range of stressful life events experienced in past years. After that, the workers were to rate the events’ intensities on a 5-point rating. Again, a Higher score showed a higher level of stress.

  1. Mood States

            The mood was determined using by means of the UWIST Mood Adjectives Checklist. It has 22 adjectives in a random sequence. Every individual adjective was scored on a 5-point intensity scale (1 meant not at all and 5 meant extremely). The results were scored for 5 scales. The five scales were hedonic tone, energetic arousal, tense arousal, anger, and general arousal. Each of these reflected a specific feeling.

            Data Analyses and Statistical Methods

            Data were analyzed by the means of a computer and other statistical programs such as SPSS. Generally, statistical analyses were based on two groups of workers: the shift workers and the day workers. Each group had a size of 100. The statistical methods applied included t-tests and correlations. Besides, the nature of data and situations in this research called for the use of more complex multivariate statistical techniques such as step-wise multiple regression according to the purpose of the analysis.

            Results

            This research employed the use of various techniques. These included descriptive statistics which helped in the quantitative description of the data and information; correlations which showed the extent to which the data from the two groups of workers are related; and step-wise multiple regression analysis which removed the weakest correlated variables. From the results of this research, it is clear that had a significantly greater score on all the variables of stress and mental health as compared to the group of day workers. Furthermore, the results pointed out that the health and well-being of day workers were better than shift workers. This is because shift workers undergo a higher level of adverse mental health outcomes as compared to the day workers.     Concerning the variations in mood status, the outcomes of this study stated that shift workers undergo a significantly higher level of arousals (both tension and energy), and anger as compared to day workers. Generally, the results showed that the manifestation of negative mental health outcomes increased with the increase in the level of stress. The size of the correlation coefficient varied from 0.201 to 0.508 and 0.213 to 0.43 respectively for day workers and shift workers. Additionally, the results stated that the workers were more likely to show symptoms of negative mental health if they experienced negative mood states. Negative mood states include increased anger levels, tense arousal, and energetic arousal. Even though the simple pair-wise correlations are instructive, they do not control for concurrent disparities in other variables. Therefore, the use of step-wise multiple regression analyses was employed to examine the effect of stress-related variables on mental health outcomes. This was separately done for both day workers and shift workers.

Discussion

            The main objective of this study was to examine the effect of meal time on psychological stress among shift workers. Generally, the results agree with other studies and provide evidence that shift workers experience a significantly higher level of psychological stress in regards to meal times. The most likely explanations of these results suggest that a disruption in the daily mealtime routines by the shift workers can lead to psychological stress. Shift working is also dangerous to the workers because it does not take into account certain requirements for medication or other routines for the health care of the shift workers. Workers in the shift systems go through more stress than the day workers. However, shiftwork may also be advantageous to some employees for some reasons. For instance, many workers work in shifts because of some factors such as pay, schedule that allows them to go to school, childcare, or the availability of work. The findings of this study also show that the night shift, in particular, has a significantly higher risk of psychological stress as compared to other workers. Also, shift workers experience long and erratic work hours. Consequently, this affects the mealtime routine of shift workers thus causing negative effects such as poor quality of sleep, bad moods, and increased psychological stress. Shift workers experience a lot of fatigue and have a greater inclination towards anxiety and depression as compared to non-shift workers. Workers that have higher psychological stress levels and shift work schedules are significantly more likely to be affected with neurotic disorders.

            Apart from meal times, other factors affect psychological stress in shift workers. These factors include disrupted circadian rhythms, sleep debt, physical inactivity, and insufficient time for rest and revitalization. Shift working, especially ones associated with night work, can change the eating behavior of shift workers. This is caused by a diverse range of social and biological factors. Consequently, this plays a role in the development of psychological stress. Again, shift workers normally feel role conflict in their jobs. This is due to factors such as incongruity in their job requirements compared to other workers, volatility of their job duties, and time pressure.

            To this end, the results of this research propose that the working shift is linked to several psychosocial problems. Shift work is highly associated with abnormal eating behavior, which affects the health well-being of the workers. The shift workers who work for long hours to ensure quality services are delivered to their customers experience psychological stress. For instance, many health care workers have been psychologically stressed due to the shifts and changes in their eating patterns, high work and personal stress, a variety of physical and mental health problems, the experience of negative mood states, low sense of mastery, and relationship problems.

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