Anxiety and inhibitory control play a chain mediating role between compassion fatigue and Internet addiction disorder among nursing staff

Abstract

Mental health problems among nurses are prevalent and harmful. Nurses worldwide have encountered serious mental health issues. Although fatigue has been proven to lead to substance abuse or addictive behaviors (such as internet addiction), there is a lack of sufficient data on whether there is a connection with compassion fatigue. Compassion fatigue is a common mental health problem in helping professions. Anxiety and inhibitory control have been demonstrated to be associated with internet addiction, but the mediating role between them in the state of compassion fatigue remains to be further explored. Therefore, this study aims to investigate the chain—mediating effect of anxiety and inhibitory control between compassion fatigue and internet addiction in the nurse population. From July to August 2024, a questionnaire survey was conducted using a convenience sampling method in 7 hospitals in Hunan Province, China. A total of 516 front—line clinical nurses were included, among whom 17 were male and 499 were female. Subjective data on compassion fatigue, internet addiction, anxiety, and inhibitory control were collected and analyzed. SPSS 26.0 and its PROCESS macro—plugin were used for data analysis. After controlling for age and gender, compassion fatigue was found to be a significant predictor of internet addiction (β = 0.40, P < 0.001). However, when anxiety and inhibitory control were added, the prediction of compassion fatigue on internet addiction in the nurse population remained significant (β = 0.18, P < 0.001). Eventually, the research results show that compassion fatigue can predict internet addiction through anxiety and inhibitory control. It is recommended that nursing managers provide appropriate emotional interventions for nurses with compassion fatigue or adjust the shift—scheduling and leave system to prevent the occurrence of internet addiction.

Full text

Anxiety and inhibitory control play
a chain mediating role between
compassion fatigue and Internet
addiction disorder among nursing
sta
Xinxin Tan1,9, Zhongzheng Li1,9, Hong Peng2, Min Tian2, Jiong Zhou4, Ping Tian5,
Jingrui Wen6, Shenglin Luo6, Yan Li3,8, Ping Li2,8 & Yang Liu7,8
Mental health problems among nurses are prevalent and harmful. Nurses worldwide have encountered
serious mental health issues. Although fatigue has been proven to lead to substance abuse or
addictive behaviors (such as internet addiction), there is a lack of sucient data on whether there is
a connection with compassion fatigue. Compassion fatigue is a common mental health problem in
helping professions. Anxiety and inhibitory control have been demonstrated to be associated with
internet addiction, but the mediating role between them in the state of compassion fatigue remains
to be further explored. Therefore, this study aims to investigate the chain—mediating eect of anxiety
and inhibitory control between compassion fatigue and internet addiction in the nurse population.
From July to August 2024, a questionnaire survey was conducted using a convenience sampling
method in 7 hospitals in Hunan Province, China. A total of 516 front—line clinical nurses were included,
among whom 17 were male and 499 were female. Subjective data on compassion fatigue, internet
addiction, anxiety, and inhibitory control were collected and analyzed. SPSS 26.0 and its PROCESS
macro—plugin were used for data analysis. After controlling for age and gender, compassion fatigue
was found to be a signicant predictor of internet addiction (β = 0.40, P < 0.001). However, when
anxiety and inhibitory control were added, the prediction of compassion fatigue on internet addiction
in the nurse population remained signicant (β = 0.18, P < 0.001). Eventually, the research results show
that compassion fatigue can predict internet addiction through anxiety and inhibitory control. It is
recommended that nursing managers provide appropriate emotional interventions for nurses with
compassion fatigue or adjust the shift—scheduling and leave system to prevent the occurrence of
internet addiction.
Keywords Compassion fatigue, Anxiety, Inhibitory control, Internet addiction
e mental health issues among nurses are widespread and harmful. Research indicates that nurses globally have
encountered serious mental health challenges, including depression, cognitive impairments, anxiety, trauma/
post-traumatic stress disorder (PTSD), burnout, sleep disorders, and other negative mental health conditions1.
According to the “Report on the Development of National Mental Health in China (2021–2022)”2, frontline
clinical medical sta experience more severe mental health issues compared to other medical personnel. Nurses,
as primary providers of medical services, oen face high levels of occupational stress, complex and variable patient
conditions, substantial workloads, and diverse interpersonal relationships, all posing signicant threats to their
1School of Medicine, Jishou University, Jishou 416000, Hunan, China. 2National Hospital of Traditional Chinese
Medicine of Xiangxi Tujia and Miao Autonomous Prefecture, Jishou 416000, Hunan, China. 3School of Mathematics
and Statistics, Jishou University, Jishou 416000, Hunan, China. 4Changsha Hospital for Maternal & Child Health
Care, Changsha 410000, Hunan, China. 5ZhangJiajie Hospital of Traditional Chinese Medicine, ZhangJiajie 427000,
Hunan, China. 6Ningxiang Hospital of Traditional Chinese Medicine, Ningxiang 410600, Hunan, China. 7School of
Sports Science, Jishou University, Jishou 410600, Hunan, China. 8Yan Li, Ping Li and Yang Liu have contributed
equally to this work. 9Xinxin Tan and Zhongzheng Li have contributed equally to this work and share rst authorship.
email: 418461251@qq.com; xpl19961225@163.com; ldyedu@foxmail.com
OPEN
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physical and mental well-being3. Compassion, a core value in healthcare settings and fundamental to delivering
high-quality psychological medical services4, is also associated with compassion fatigue, a common ment al health
issue among caregiving professions5. Compassion fatigue refers to the secondary traumatic stress or vicarious
traumatization experienced by caregivers who are repeatedly exposed to empathetic or traumatic situations,
leading to compassion stress and exhaustion6,7. Nurses, recognized as one of the most “caring” professions, oen
experience varying degrees of anxiety, depression, self-reproach, insomnia, lack of concentration, and low job
satisfaction when suering from compassion fatigue8,9, which can lead to medical errors, tense nurse-patient
relationships, decreased nursing quality, and even hinder the professional development of nurses and result in
the loss of nursing team human resources, increasing the burden on the hospital system10, erefore, researching
compassion fatigue among nursing sta is of great practical signicance.
e internet has brought immense convenience to the information age, oering opportunities for
entertainment and social interaction. Despite its utility for work and socializing, inappropriate internet use is
a recurring issue. is behavior is commonly referred to as “Internet addiction,” also known as “pathological
internet use,”11, which describes a loss of control over internet use and a psychological state that arises without
the inuence of addictive substances. is can lead to decreased eciency in learning and work, emotional
distancing, and a decline in interpersonal skills12. It is therefore necessary to explore the mechanisms underlying
Internet addiction. Although Internet addiction has been conrmed to be widespread among adolescents13–15,
it can also occur in adults and may be associated with a greater burden of psychiatric symptoms and fatigue16.
According previous studies, internet addiction has a signicant impact on the physical and mental health
development of college students, and there is a correlation between negative emotions, fatigue, and internet
addiction among college students16–21.
For frontline clinical nurses, the psychological and mental burden is substantial, encompassing self-
perceived anxiety, depression, stress, and job burnout22,23. e “Internet Compensation eory” posits that
when individuals experience a lack of psychological needs fulllment in real-life environments—such as social
isolation, diculty in stress relief, or insucient sense of achievement—they may turn to internet activities
(e.g., social media interaction, gaming, short videos) to compensate for these deciencies, leading to dependent
behaviors24. In other words, internet activities can compensate for psychological and social issues, fullling needs
that cannot be met in real life, thereby increasing the likelihood of Internet addiction25–29. Furthermore, due to
the informatization of modern healthcare systems, nursing sta’s daily tasks—from patient contact, medication
acquisition, treatment and precautionary advice, to patient health education and nursing student training—are
all closely related to the internet30, is particularity makes nursing sta susceptible to Internet addiction31.
Moreover, due to the caring nature of their profession, nursing sta inevitably invest more emotionally in their
patients, generally possessing higher levels of compassion, which can lead to compassion fatigue32,33. However,
the negative emotions brought about by compassion fatigue, such as anxiety, depression, and irritability, are
not uncommon34,35. e self-control model suggests that an individual’s psychological resources are nite, and
self-control relies on limited cognitive resources36. Self-control behavior can be described as the process by
which an individual attempts to control or overcome dominant behavioral or response tendencies to achieve
specic goals. When resources are depleted due to fatigue, stress, or excessive consumption, focus and eciency
decrease, making individuals more susceptible to the allure of the internet37,38. A meta-analysis has proposed
that internal variables statistically have a greater impact on Internet addiction than interpersonal variables39.
erefore, exploring the inuencing factors and potential mechanisms of Internet addiction among frontline
clinical nurses is of signicant importance. Based on the above analysis, this study hypothesizes that nurses
with high levels of compassion fatigue may tend to alleviate their stress through risky behaviors, and there is a
signicant correlation between compassion fatigue and Internet addiction (H1).
Previous studies have indicated that various psychological factors mediate between negative emotions and
Internet addiction40,41, particularly anxiety. Anxiety is a common emotional state among nursing sta42, typically
associated with events that have not occurred or have uncertain outcomes43,44. A substantial amount of research
has shown a correlation between anxiety and Internet addiction45–51, with characteristic anxiety even serving
as one of the predictive factors for Internet addiction52. A longitudinal study conducted on 648 adolescents at
dierent ages demonstrated that higher levels of anxiety were signicantly associated with greater IA behaviors53;
additionally, a study in Macau, China, surveyed 11 secondary schools and found that social anxiety mediated
between adolescent victimization experiences and Internet addiction54. Concurrently, numerous studies have
shown a certain correlation between anxiety and compassion fatigue55,56, and the neurobiological mechanisms
of compassion and anxiety may interact, with increased communication between the le amygdala and insula
associated with higher levels of compassion, worry, and rumination57. Similarly, when individuals face emotions
such as fear and anxiety, the anterior insula cortex also exhibits abnormal activity58. Coping theory suggests that
when individuals are under stress and threat, they adopt a series of measures to cope with stress assessment,
with escape coping being one of them59. e nature of escape coping is avoidance rather than problem-solving,
and Internet use may merely serve as an individual’s window to cope with reality, reducing anxiety and stress,
while Internet addiction is, in turn, correlated with emotions such as depression, anxiety, perceived stress, and
perceived burnout60,61. Given the link between anxiety and compassion fatigue and Internet addiction, it is
believed that compassion fatigue may directly lead to Internet addiction, and anxiety may act as a mediator
between compassion fatigue and Internet addiction (H2).
Another variable oen associated with Internet addiction is inhibitory control. Inhibitory control refers to
the ability to suppress irrelevant stimuli and behavioral responses, which is an essential component of executive
functions62. Compared to the general population, individuals with Internet addiction oen exhibit poorer
inhibitory control63. A study conducted in 2012 using functional magnetic resonance imaging (fMRI) and
the Stroop task to examine the neural correlates of response inhibition in individuals with Internet addiction
found that these individuals had signicantly increased activity in the anterior cingulate cortex and posterior
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cingulate cortex, indicating reduced eciency in the response inhibition process64. Moreover, an individual’s
inhibitory control is not static; research indicates that negative emotions can signicantly aect an individual’s
level of inhibitory control65,66,67. A meta-analysis showed a close relationship between aective compassion and
inhibitory control68. At the same time, medical students and healthcare workers, especially frontline clinical
nursing sta who have the most contact with patients on a daily basis, may experience a decrease in neural
responses to pain information in the anterior insula due to excessive direct or indirect exposure to patient
suering. e anterior insula is an area of the brain associated with processing pain and negative emotions,
and this can lead to reduced levels of brain inhibitory control66. erefore, we hypothesize that compassion
fatigue is associated with weakened inhibitory control, and inhibitory control may play a mediating role between
compassion fatigue and Internet addiction (H3).
Anxiety also weakens an individual’s inhibitory control abilities, with higher levels of anxiety corresponding
to lower levels of inhibitory control69–71. Research has found that the key to the generation of anxiety lies in the
amygdala of the brain’s basal lateral area, which heavily relies on inhibitory control72, indicating an interactive
relationship between the two. As previously mentioned, individuals with compassion fatigue are more susceptible
to anxiety, and seeking “rewards” or short-term pleasure can easily lead to Internet addiction and weakened
behavioral control11. Based on the above analysis, we propose a hypothesis that anxiety and inhibitory control
may mediate the relationship between compassion fatigue and Internet addiction (H4).
In light of the above discussion, it is essential to investigate compassion fatigue, anxiety, and inhibitory
control among frontline clinical nursing sta. is research is aimed at curbing the risk of Internet addiction
among nurses, managing their psychological health, and fostering the sustainable development of nursing
teams. However, there is still a dearth of empirical and objective data regarding the actual experiences of the
nursing community. us, the purpose of this study is to explore the relationship between compassion fatigue
and Internet addiction among frontline clinical nurses, as well as the mediating roles of anxiety and inhibitory
control. Based on this, we have formulated a hypothesis that compassion fatigue is positively correlated with
Internet addiction among frontline clinical nurses. Furthermore, the relationship between compassion fatigue
and Internet addiction is hypothesized to be mediated by anxiety and inhibitory control (See Fig. 1). e
hypotheses are as follows:
H1 Compassion fatigue positively signicantly predicts Internet addiction.
H2 Compassion fatigue signicantly positively predicts anxiety, which in turn signicantly positively predicts
Internet among addiction nursing sta.
H3 Compassion fatigue signicantly negatively predicts inhibitory control, which in turn signicantly positive-
ly predicts Internet addiction among nursing sta.
H4 Anxiety and inhibitory control have a serial mediating eect between compassion fatigue and Internet ad-
diction among nursing sta.
Methods
Participants
From July to August 2024, a convenience sampling method was employed to recruit 533 frontline clinical nurses
from seven tertiary hospitals in Hunan Province, China. e inclusion criteria were: (1) possession of a nursing
practice qualication certicate; (2) providing informed consent for this study. e exclusion criteria were: (1)
interns, standardized training, or further education nurses; (2) non-frontline clinical positions, such as those
dedicated to research, management, teaching, logistics, etc.; (3) nurses who had undergone psychotherapy or
psychopharmacological treatment within the past three months. All participants voluntarily and freely joined
the study, and the testing sta explained the survey content, data anonymity, condentiality, and usage to the
participants before distributing the questionnaires, informing them of their right to withdraw at any time. It
Fig. 1. Hypothesis mediation model.
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took participants no more than 20min to complete the questionnaire. Informed consent was obtained online
from all participants. Aer screening the collected data and excluding responses that were incomplete or showed
obvious patterned answering, the nal analysis sample for this study included 516 participants (17 males and
499 females). is study has been approved by the Biomedical Ethics Committee of Jishou University (approval
number: JSDX–2024–0125). Basic information is presented in Table 1.
Measurement tools
Compassion fatigue
e Chinese version, translated and revised by Chen et al.73, consists of 30 items across three dimensions.
ese include 10 items on compassion satisfaction (items 2, 5, 7, 9, 11, 13, 14, 23, 25, 28), 10 items on job
burnout (items 1, 4, 8, 10, 15, 17, 19, 21, 26, 29), and 10 items on secondary traumatic stress (items 3, 6, 12,
16, 18, 20, 22, 24, 27, 30). e Likert 5-point scoring method is utilized, where 1 indicates “never,” 2 indicates
“rarely,” 3 indicates “occasionally,” 4 indicates “oen,” and 5 indicates “always.” compassion satisfaction represents
a positive dimension reecting a positive trend, while job burnout and secondary traumatic stress represent
negative dimensions reecting a negative trend. e critical values for each dimension are as follows: compassion
satisfaction < 37 points, job burnout > 27 points, and secondary traumatic stress > 17 points. In this study, the
Cronbach’s α coecient was 0.91.
Internet addiction
Validated and revised by Wei74, the scale comprises eight items, ranging from 8 to 40 points, with each item
assessed using a 5-point Likert scale, from 1 (strongly disagree) to 5 (strongly agree). Higher scores indicate a
higher level of Internet addiction. In this study, Cronbach’s α was 0.95.
Anxiety
e depression anxiety stress scale-21 (DASS-21), revised into Simplied Chinese by Gong et al.75, consists of
21 items, with seven items pertaining to anxiety, ranging from 7 to 28 points. Each item uses a 4-point Likert
scoring system, from 1 (very disagree) to 4 (very agree). Higher scores indicate a higher level of anxiety. In this
study, the Cronbach’s α was 0.90.
Inhibitory control
Developed by Huang et al.76, the Executive Function Scale measures inhibitory control ability using the cognitive
exibility sub-scale. e sub-scale consists of six items, each rated on a scale from 1 (“oen”) to 3 (“never”). e
total score of these items represents the level of inhibitory control, ranging from 6 to 18. A higher score indicates
a higher level of inhibitory control. In this study, the Cronbach’s α coecient for this sub-scale was 0.90.
Statistical analysis
Before analyzing the data, the present study conducted a common method bias (CMB) test. Following the
recommendations of Podsako et al., a threshold of 40%77 was set to determine whether signicant bias
existed in the data. Secondly, the four main variables in this study were presented in terms of means and
standard deviations (SD) and were subjected to descriptive and correlational analysis using SPSS 26.0. Prior
to conducting the analysis, a normality test was performed on the data. Following the guidelines of Kim78,
the data were considered approximately normally distributed if the absolute values of skewness were less than
2 and the absolute values of kurtosis were less than 7. e results of the normality tests conrmed that the
main variables in this study followed a normal distribution, allowing for the use of parametric tests. Specically,
independent sample t-tests and one-way ANOVA were employed to examine dierences between gender and
grade, while Pearson correlation analysis was used to assess the relationships between variables. Additionally, the
mediation model was tested using the PROCESS 4.0 macro in SPSS. Prior to conducting the mediation analysis,
the variables were standardized. Compassion fatigue was set as the independent variable, internet addiction as
Demographic variables Number (N)
Gender
Male 17
Female 499
Only child
Yes 92
No 424
Age
18–23 44
24–30 145
31–35 135
36–40 75
41–45 63
≥ 46 54
Tab le 1. Demographic characteristics.
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the dependent variable, and Anxiety and inhibition control dependence as the mediators, with demographic
variables included as covariates in the chain mediation model (Model 6)79. To assess model t and estimate 95%
condence intervals (95% CI), 5000 bootstrap resampling iterations were performed, ensuring the robustness of
the analysis80. e signicance level was set at 0.05.
Results
Common method bias test
In order to evaluate the inuence of common method bias, Harman’s single-factor test was utilized. e results
of this analysis indicated that, in the absence of Principal component factor rotation, two factors exhibited
eigenvalues surpassing the value of 1. e rst factor was found to explain 36.38% of the variance, falling short of
the 40% cuto. erefore, it is concluded that signicant common method bias is not present in this study. is
nding is crucial for the validity of the results, as it suggests that the observed relationships among the variables
are not artifactually inated by the method of data collection.
Correlation analysis
e results depicted in Table 2 reveal signicant correlations among the variables of interest. Compassion fatigue
exhibited a positive correlation with both internet addiction (r = 0.39, P < 0.001) and anxiety (r = 0.52, P < 0.001)
within the nursing cohort, while a negative correlation was observed with inhibitory control (r = − 0.29, P < 0.001)
Anxiety was found to be negatively correlated with inhibitory control (r = − 0.31, P < 0.001) and positively
correlated with internet addiction (r = 0.49, P < 0.001). Furthermore, inhibitory control displayed a negative
correlation with internet addiction (r = − 0.31, P < 0.001) among nursing sta. ese correlations underscore the
interrelated nature of these Psychological constructs and their potential negative impacts impact on the mental
health and behavioral tendencies of frontline clinical nurses.
Mediation analysis
Following the control for gender and age, compassion fatigue was identied as a direct and signicant predictor
of internet addiction within the nursing population (β = 0.40, SE = 0.04, P < 0.001). Moreover, in the examination
of indirect eects, the predictive inuence of compassion fatigue on internet addiction among nurses was still
found to be signicant (β = 0.18, SE = 0.04, P < 0.001). Compassion fatigue was a signicant positive predictor
of anxiety among nursing sta (β = 0.53, SE = 0.04, P < 0.001), and anxiety was a signicant positive predictor
of internet addiction (β = 0.33, SE = 0.05, P < 0.001). Furthermore, compassion fatigue was a signicant negative
predictor of inhibitory control (β = −0.15, SE = 0.05, P < 0.05), and inhibitory control was a signicant negative
predictor of internet addiction (β = − 0.16, SE = 0.04, P < 0.001). Lastly, anxiety was a signicant negative
predictor of inhibitory control (β = − 0.26, SE = 0.05, P < 0.001). e mediation analysis of empathy fatigue’s eect
on internet addiction among nursing sta is detailed in Tables 3 and 4 and visualized in Fig.2. ese ndings
underscore the complex interplay between empathy fatigue, anxiety, inhibitory control, and internet addiction,
highlighting the importance of considering these factors in the context of nursing Practice and mental health.
Discussion
To the best of our knowledge, few studies have investigated the relationships among compassion fatigue, internet
addiction, anxiety, and inhibitory control in the nurse population. As for the results, a signicant positive
correlation was found between compassion fatigue and internet addiction. rough mediation analysis, we
discovered that anxiety and inhibitory control played a signicant chain—mediating role in the relationship
between compassion fatigue and internet addiction among nursing sta.
Specically, compassion fatigue among nursing sta can inuence internet addiction through four pathways.
Firstly, compassion fatigue directly aects internet addiction. Secondly, compassion fatigue exacerbates anxiety,
which in turn induces internet addiction. irdly, compassion fatigue weakens inhibitory control, thereby
accelerating the development of internet addiction. Fourthly, compassion fatigue exacerbates anxiety, which
then weakens inhibitory control, thus promoting internet addiction. ese factors, either individually, through
mutual inuence, or by compounding their negative impacts, increase the risk of internet addiction.
In the sample of the current study, the demographic data such as age, gender, educational background, and
whether they are only children exhibit certain characteristics. e age group with a relatively large proportion is
mainly the young population, which is related to the nature of the nursing profession. Nursing is a profession that
1 2 3 4 5 6
1 Gender –
2 Age 0.13** –
3 Compassion fatigue − 0.01 0.06 –
4 Internet addiction − 0.03 − 0.15*** 0.39*** –
5 Inhibitory control − 0.06 − 0.09* − 0.29*** − 0.31*** –
6 Anxiety − 0.04 − 0.14** 0.52*** 0.49*** − 0.31*** –
M – – 74.58 18.76 13.29 13.25
SD – – 12.02 9.82 2.62 4.64
Tab le 2. Correlations among the variables. **: P ＜ 0.01;***: P < 0.001.
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requires both physical strength and emotional management81. Moreover, newly recruited nurses and those with
less seniority may face a higher risk of compassion fatigue82. In addition, the majority of the research subjects
are female, which is consistent with the national conditions in China. According to the report of the National
Health Commission of China in 2023, as of 2022, men accounted for only 3.4% of registered nurses in China83.
In this study, the nurse group was in a state of a certain degree of compassion fatigue. For front-line clinical
nurses, in addition to their daily specic nursing work, they need to be constantly exposed to the emotional pain
and trauma of others84, long-term continuous emotional output and emotional investment not only have an
adverse impact on the physical and mental health of nurses but also aect work eciency and weaken patient
care85. e conservation of resources theory posits that individuals are motivated to build, protect, and cultivate
their resource pool86. When nurses’ psychological capital is exhausted, they will seek ways to manage resources87,
and the Internet is one of them. A previous study in Italy also showed that the internet addiction scores of the
nurse group were higher than those of normal subjects88, which is consistent with our research, indicating that
Fig. 2. Chain mediation model test.
Mediation model paths Eect SE Bootstrap 95% CI Proportion of mediating eect (%)
Total eect 0.40 0.04 0.32, 0.48
Direct eect 0.18 0.04 0.09, 0.27
Total indirect eect 0.22 0.03 0.16, 0.29 54.70
Compassion fatigue  Anxiety  Internet addiction 0.18 0.03 0.12, 0.24 43.32
Compassion fatigue  Inhibitory control  Internet addiction 0.02 0.01 0.01, 0.05 5.94
Compassion fatigue  Anxiety  Inhibitory control  Internet addiction 0.02 0.01 0.01, 0.04 5.45
Tab le 4. Mediation model paths.
Outcome variables Predictive variables βSE t R2F
Internet addiction
Compassion fatigue 0.40 0.04 10.10***
0.19 38.99***Age − 0.18 0.04 − 4.38***
Gender − 0.01 0.04 − 0.04
Anxiety
Compassion fatigue 0.53 0.04 14.40***
0.30 74.34***Age − 0.17 0.04 − 4.60***
Gender − 0.02 0.04 − 0.46
Inhibitory control
Compassion fatigue − 0.15 0.05 − 3.02**
0.14 20.18***
Anxiety − 0.26 0.05 − 5.18***
Age − 0.11 0.04 − 2.69**
Gender − 0.06 0.04 − 1.46
Internet addiction
Compassion fatigue 0.18 0.04 4.12***
0.31 44.68***
Anxiety 0.33 0.05 7.24***
Inhibitory control − 0.16 0.04 − 4.12***
Age − 0.13 0.04 − 3.44**
Gender − 0.01 0.04 − 0.14
Tab le 3. Chain mediation model test. *: P < 0.05; **: P < 0.01; ***: P < 0.001.
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although nurses are professional healthcare workers, they still have digital health problems. Unreasonable use of
the Internet can bring a series of negative eects, such as increased anxiety and reduced inhibitor y control ability,
which may further exacerbate internet addiction.
erefore, to prevent internet addiction among nursing sta, nursing managers should pay attention
to nurses’ mental health and strengthen psychological counseling. For example, various emotional catharsis
approaches can be adopted, such as group psychological counseling89, mindfulness—based stress reduction,
and the Feldenkrais awareness through movement intervention90, to alleviate emotional disorders such as
compassion fatigue among the nurse group (H1).
In addition, according to the results of the mediating eect, compassion fatigue not only directly aects
internet addiction but also indirectly inuences it through the exacerbation of anxiety and the weakening of
inhibitory control ability. Research indicates that individuals with a high level of compassion are prone to a series
of negative emotions such as anxiety and depression91.e underlying mechanism may be related to brain regions
associated with compassion and emotion processing, such as the amygdala and the anterior cingulate cortex.
During compassion fatigue, these regions are over—activated. e amygdala enhances the response to negative
emotions, and the anterior cingulate cortex, which is involved in emotion regulation and cognitive control, when
over—activated, disrupts the balance, making individuals more likely to experience anxiety92. Anxiety not only
reduces the connectivity between the amygdala and the prefrontal cortex93 but also weakens cognitive executive
function94, thereby increasing the risk of internet addiction95. An overly anxious individual may be restless,
ustered, and unable to concentrate, with reduced stress—resistance and coping abilities. As a result, they are
easily attracted by information such as online pop—ups, increasing the risk of internet addiction51,96. (H2).
Emotions can enhance or magnify cognitive processes and behavioral responses97. Individuals who are
exposed to negative emotions for an extended period oen experience emotional exhaustion due to long—
term over—compassion with others’ negative emotions. e negative eect causes attentional biases in them,
making them more inclined to focus on information that allows them to temporarily escape the fatigued state in
reality. For example, when browsing the web, they may be more easily attracted to light-hearted and entertaining
content98. Compassion fatigue is more of a psychological state of exhaustion. Football players in a state of
psychological fatigue experience a decline in their decision—making cognitive abilities99 Similarly, nurses in a
state of compassion fatigue oen experience emotional depletion100.When an individual experiences compassion
fatigue, they may have diculty concentrating, be easily startled, and struggle to maintain an objective attitude.
ese symptoms can aect inhibitory control ability because inhibitory control requires cognitive resources and
focused attention, and compassion fatigue may deplete these resources101. A study has found that individuals
with a tendency towards internet addiction are more impulsive and share common neuropsychological and
event—related potential (ERP) characteristics with addicted patients102. erefore, compassion fatigue may
indirectly increase the risk of internet addiction by weakening inhibitory control ability (H3).
Research indicates that anxiety is one of the characteristic manifestations of individuals with internet
addiction103. Individuals with anxiety oen experience impairments in cognitive control processes, including
inhibitory ability104. Inhibitory control ability is typically negatively correlated with internet addiction105. A
decrease in inhibitory control ability increases the likelihood of internet addiction, and internet—addicted
individuals oen have impaired prefrontal—related inhibitory control, which plays a crucial role in inhibitory
control106. Our research ndings suggest that nurses experiencing compassion fatigue may increase their risk
of internet addiction through a pathway where increased anxiety leads to weakened inhibitory control ability,
which is consistent with previous research107 erefore, given the negative impact of compassion fatigue
ultimately leading to internet addiction, it is necessary to take measures to mitigate its eects. Specically, health
management departments could incorporate compassion fatigue into occupational health management and
include the results in occupational health records. Nursing managers could improve the shi—rotation and leave
systems. When scheduling shis for hospital nurses, they should be empathetic, avoid consecutive night shis,
or implement “mental health leave” and the like. Nurses could alleviate stress and regulate emotions through
mindfulness meditation, cognitive-behavioral therapy, or regular physical exercise. ese methods not only help
in managing negative emotions but also enhance overall mental well-being. However, the intervention measures
proposed in our study dier from previous research on promoting nurses’ compassion regarding compassion
fatigue108. us, specic measures need to be carried out according to dierent conditions (H4).
Strengths and limitations
Previous research on internet addiction oen focused on adolescents or medical students, with relatively few
studies paying attention to internet addiction among nurses. is study attempts to analyze the proportion of
internet addiction in the nurse population and, by incorporating compassion fatigue, a common state among
nurses, provides some theoretical reference for future psychological interventions for clinical nurses, which is
of certain signicance. However, like most studies, this research also has some limitations. Firstly, this study is
a cross—sectional research, lacking objective measurement data and neurophysiological indicators. is type
of research restricts the ability to explain causal relationships among variables. Secondly, the data source is
the nurse population in the central and western regions of Hunan Province. All participants are Chinese, and
due to the internal gender imbalance within the nurse group, the dierences between genders were not taken
into account. erefore, caution should be exercised when interpreting and generalizing the results. Finally, the
data are sourced from the self—reports of the nurse group, which may carry certain self—reporting risks. e
results may be subjective, thus undermining the relative objectivity of the ndings. Based on these limitations,
we acknowledge the need for follow-up research on anxiety, inhibitory control, and internet addiction caused
by compassion fatigue. Adding objective neurophysiological indicators, such as functional magnetic resonance
imaging, can enhance the objectivity and interpretability of the results. Alternatively, conducting a larger-scale
Scientic Reports | (2025) 15:12211 7
| https://doi.org/10.1038/s41598-025-95832-y
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Content courtesy of Springer Nature, terms of use apply. Rights reserved

study with a more balanced gender distribution, covering dierent genders and regions, can be carried out to
verify and compare the research results among dierent genders and ages.
Conclusion
is study further claries the potential mechanisms underlying the relationship between front—line clinical
nurses in Hunan province, China, and internet addiction. Compassion fatigue can directly and negatively predict
internet addiction among nurses. It can also indirectly predict internet addiction among nurses through anxiety
and inhibitory control, and simultaneously negatively predict nurses’ internet addiction via these two pathways.
Data availability
e datasets generated and/or analysed during the current study are not publicly available due [our experimental
team’s policy] but are available from the corresponding author on reasonable request.
Received: 24 October 2024; Accepted: 24 March 2025
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Acknowledgements
anks to Xinxin Tan, a gentle and careful girl, for her great contribution to this research.
Author contributions
Xinxin Tan contributed to the Manuscript by undertaking the Primary writing and data collection eorts.
Zhongzheng Li Played a Pivotal role in the Peer review Process and also Participated in data collection activi-
ties. e data collection team was comprised of Hong Peng, Min Tian, Jiong Zhou, Ping Tian, Jingrui Wen, and
Scientic Reports | (2025) 15:12211 10
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Shenglin Luo. Yan Li oered her expertise in statistics, Providing guidance throughout the research Process, and
also contributed to the review of the manuscript. Ping Li’s eorts were focused on data collection. Lastly, Liu
Yang was instrumental in Performing the statistical analysis and Played a signicant Part in the editorial review
of the manuscript.
Declarations
Competing interests
e authors declare no competing interests.
Ethical approval and consent to participate
e research Protocol was reviewed and approved by the Biomedical Ethics Committee at Jishou University,
with the approval number JSDX–2024–0125. Prior to the start of the study, informed consent was secured
from all individuals who participated in the research, ensuring their understanding and voluntary agreement
to Partake in the study Procedures. is adherence to ethical standards guarantees the Protection of the rights
and welfare of the study participants, which is a fundamental requirement in scientic research.
Additional information
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