Mental health trajectories during new nurses' role transition: staged reversal of the resilience-depression and resilience-anxiety relationship.

OBJECTIVE: This study examines the dynamic trajectories of resilience, depression, and anxiety during novice nurses' three-year role transition, with particular attention to the phase-dependent reversals in the resilience-depression and resilience-anxiety relationships, to inform temporally differentiated psychological interventions. METHODS: In this prospective longitudinal cohort study, 118 newly employed nurses were recruited at baseline (T0) from a tertiary grade A hospital in Lanzhou, China (2019-2021), and 102 (86.4%) completed assessments at T0 and at the end of Years 1-3 (T1-T3). Resilience, depression, and anxiety were measured using the CD-RISC, SDS, and SAS, respectively. Data were analyzed using linear mixed-effects models, Pearson correlation with Steiger's Z-tests, group-based trajectory modeling (GBTM), and hierarchical regression. RESULTS: Resilience increased steadily across the 3 years (64.65-81.01, P < 0.001). Depression followed a U-shaped trajectory, reaching its nadir at T2 (50.49) before rebounding at T3 (55.64, P < 0.001). In contrast to depression's U-shaped trajectory, anxiety exhibited chronic stability with only a late-stage increase from T2 to T3 (P = 0.004). The resilience-depression association reversed over time: negative at T0 (r = -0.264, P = 0.007), non-significant at T1-T2, and positive at T3 (r = 0.377, P < 0.001); Steiger's Z-test confirmed this reversal was statistically significant (Z = -5.720, P < 0.001). GBTM identified three latent trajectory classes for depression, including a low-fluctuating class (32.35%) exhibiting U-shaped recovery then rebound. Hierarchical regression revealed that explanatory power was highest at T0 → T1 and became non-significant at T2 → T3. CONCLUSION: The resilience-depression association shifted from negative to positive over the role transition. The depression rebound at T2 marks a critical intervention window. Anxiety demonstrated chronic stability, necessitating strategies distinct from depression-focused approaches. A staged mental health monitoring system is recommended.