Mental Health, Burnout and Turnover Intention among Nurses in Conflict-Affected Yemen: A Multicentre Study Across Eight Accessible Governorates

This project contains all supplementary materials for the study entitled "Mental Health of Nurses in Protracted Armed Conflict: Multicenter Evidence from Yemen's Collapsing Health System," which investigates the prevalence, determinants, and pathways of psychological distress, burnout, and turnover intention among nurses working in conflict-affected Yemen. Study Background: Yemen is experiencing one of the world's most severe and protracted humanitarian crises, with over a decade of armed conflict, health system fragmentation, economic collapse, and mass displacement. Nurses, as the backbone of health service delivery in fragile systems, bear the dual burden of occupational stress and conflict-related trauma. Despite their critical role, the mental health of Yemeni nurses remains profoundly understudied. Study Objectives: 1. Estimate the prevalence of depression, anxiety, burnout, and turnover intention among nurses in conflict-affected Yemen. 2. Identify occupational and conflict-related factors associated with these outcomes. 3. Examine the mediating role of burnout and the moderating role of psychological support in the relationship between conflict exposures and psychological distress. Methods: We conducted a national, multicenter cross-sectional study from January to December 2025, enrolling 800 registered nurses from 24 health facilities across eight conflict-affected governorates using multistage cluster sampling. Depression and anxiety were assessed using validated Arabic versions of the PHQ-9 and GAD-7 (cut-off ≥10 for moderate-to-severe symptoms). Burnout was measured using a validated single-item scale, and turnover intention was assessed with a direct question. Mixed-effects multivariable logistic regression accounted for facility-level clustering, and path analysis examined mediation and moderation pathways. Key Findings: · Prevalence of moderate-to-severe depression: 52.0% · Prevalence of moderate-to-severe anxiety: 47.0% · Prevalence of high burnout: 34.0% · Prevalence of turnover intention: 54.8% · Displacement, workplace violence, inadequate income, and high nurse-patient ratios (≥1:20) were independent predictors of distress. · Burnout mediated 42.3% of the violence-depression association and 38.7% of the displacement-anxiety association. · Access to psychological support significantly buffered the mental health impact of conflict exposures. Repository Contents (Files S1–S11): File Description S1_De-identified_Dataset.csv Full de-identified dataset in CSV format for replication S2_Study_Instruments_Consent_Forms.docx PHQ-9, GAD-7, burnout measure, and bilingual consent forms S3_Ethical_Approval_Documents.docx IRB approval (YEM-IRB-2025-094) and facility approvals S4_Supplementary_Tables.docx Tables S1–S7 (linear regression, ordinal regression, subgroups, etc.) S5_Supplementary_Figures.docx Figures S1–S3 (mediation model, synergistic effects, flow diagram) S6_Statistical_Analysis_Code.R Complete annotated R script for all analyses S7_Data_Dictionary_Codebook.docx Full variable definitions and coding rules S8_Sensitivity_Analysis_Report.docx Multiple imputation, model checks, and robustness analyses S9_Reporting_Checklists.docx STROBE, SAGER, CHERRIES, and conflict-ethics checklists S10_Study_Protocol.docx IRB-approved protocol (Version 2.0) with full methodology S11_Supplementary_Materials_Index.docx Complete index of all files (this document) License: All materials are made available under a Creative Commons Attribution 4.0 International (CC BY 4.0) license. Researchers using these materials are encouraged to cite the original publication.