INVESTIGATING THE ASSOCIATION OF IMPOSTER SYNDROME WITH DEPRESSION, ANXIETY AND STRESS OF NURSES IN GOVERNMENT TEACHING HOSPITAL SHAHDARA, LAHORE

Abstract

Background: Nurses in high-acuity tertiary care settings are particularly vulnerable to psychological distress. While systemic occupational stressors are well documented, internalized experiences such as Imposter Syndrome (IS) remain critically understudied, particularly in the Pakistani context, and their specific association with depression, anxiety, and stress among practicing nurses has not previously been established. Objectives: To assess the prevalence of Imposter Syndrome among nurses of Government Teaching Hospital Shahdara, Lahore, and to examine its association with depression, anxiety, and stress. Methods: An analytical cross-sectional study was conducted over six months among 123 nurses selected by simple random sampling from a total population of 177. Data were collected using a self-administered questionnaire comprising the Clance Imposter Phenomenon Scale (CIPS) and the Depression Anxiety Stress Scale (DASS-21), and analyzed in SPSS version 26. Shapiro-Wilk and Kolmogorov-Smirnov tests assessed normality; Spearman's correlation and the Kruskal-Wallis H test examined associations. Results: The mean CIPS score was 63.17 (SD=20.40), placing the participants in the 'Frequent' imposter-feelings category. Nearly half the sample (48.8%) reported Intense or Frequent levels of IS. Concurrently, clinically elevated depression, anxiety, and stress were reported in 69.9%, 79.7%, and 85.4% of participants, respectively. Contrary to the study hypothesis, Spearman's correlation revealed no statistically significant association between CIPS scores and any DASS-21 subscale (Depression: r=0.031, p=0.735; Anxiety: r=-0.153, p=0.091; Stress: r=-0.004, p=0.966). A clinically notable, though non-significant, trend showed CIPS scores rising monotonically with nursing experience (H=6.701, p=0.082). Conclusion: Imposter Syndrome is highly prevalent among nurses in the study setting, co-existing with alarming levels of depression, anxiety, and stress. This pattern likely reflects a ceiling effect of psychological distress driven by systemic occupational stressors, emphasizing the need for institutional interventions addressing both internalized and systemic sources of nurses' psychological burden.