Depressive symptoms, insomnia, and burnout among health-care workers in an integrated medical alliance in Shanghai: implications for workforce well-being and health-system management.

Background: Health-care workers' mental health is closely related to workforce stability, quality of care, and health-system resilience. In China, medical alliances are a model for integrating tertiary hospitals, secondary hospitals, and community health-service centres, but evidence on staff mental health within such systems remains limited. The primary objective was to describe the distribution and severity of depressive symptoms, anxiety symptoms, perceived stress, insomnia, and burnout dimensions; the secondary, exploratory objective was to examine adjusted associations with selected demographic and occupational characteristics. Methods: We audited item-level data from an institution-based cross-sectional online survey conducted in 2024 among health-care workers in a Shanghai medical alliance. Exact duplicate exported records were removed. Depression, anxiety, and stress were scored separately using the DASS-21; sleep symptoms were scored with the ISI; and MBI-GS exhaustion, cynicism, and professional efficacy were analysed as separate dimensions. Internal consistency, multiplicity-adjusted subgroup comparisons, and indicator-coded multivariable models were evaluated. Results: The supplied file contained 669 rows; 175 were literal copies of earlier records, leaving 494 unique respondents. Descriptively, mean (SD) scores were 9.53 (8.61) for depression, 8.81 (7.95) for anxiety, 11.84 (8.71) for stress, and 9.12 (6.16) for ISI. Scores at or above the mild-symptom threshold occurred in 47.6, 48.6, and 29.4%, respectively; 51.4% scored above the ISI no-clinically-significant-insomnia range. Mean MBI-GS dimension scores were 2.58 (1.62) for exhaustion, 2.26 (1.41) for cynicism, and 3.65 (1.21) for professional efficacy. Cronbach's alpha ranged from 0.798 to 0.959. In unadjusted subgroup comparisons, only ISI differences by years of work remained statistically significant after Holm correction across 70 tests. In exploratory adjusted models, on-call work was associated with higher depression, anxiety, and ISI scores, and age was associated with ISI; these estimates did not account for institution-level clustering and should not be interpreted as causal effects. Conclusion: The results indicate a substantial burden of psychological symptoms and measurable burnout dimensions in this medical alliance. Most unadjusted subgroup differences did not withstand multiplicity correction, whereas only a small number of associations were observed in exploratory adjusted models. These findings are non-causal and require confirmation with institution-clustered analyses before being used to define target groups.