Abstract :

Background: Increasing workloads among nurses working at community health centers, driven by high service demands and limited staffing, may adversely affect mental health, particularly symptoms of depression, anxiety, and stress.

Objective: To examine differences in depression, anxiety, and stress scores across workload categories among nurses working at community health centers administered by the Metro City Health Office.

Methods: This cross-sectional study was conducted from November 2025 to July 2026 at 11 community health centers. A total of 55 nurses were recruited using purposive sampling. Workload was assessed using the National Aeronautics and Space Administration Task Load Index (NASA-TLX), whereas depression, anxiety, and stress were measured using the Depression Anxiety Stress Scale-21 (DASS-21). Data were analyzed using descriptive statistics and the Kruskal-Wallis test, with statistical significance set at p < 0.05.

Results: Most respondents had a high workload (60.0%). The largest proportions of respondents were classified as normal for depression (49.1%), anxiety (54.5%), and stress (83.6%). The Kruskal-Wallis test showed significant differences in depression (p = 0.006), anxiety (p = 0.001), and stress (p = 0.040) scores across workload categories. The high-workload group had the highest mean ranks for depression (33.27), anxiety (34.67), and stress (32.26).

Conclusion: Depression, anxiety, and stress scores differed significantly across workload categories, with the highest mean ranks observed among nurses in the high-workload category. Equitable workload distribution and accessible psychosocial support are needed to protect nurses’ mental health and maintain the quality of healthcare services.

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Keywords :

Anxiety, Community health center, Depression, Nurses., Stress, Workload

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References :

1. Statistics Indonesia, Metro City. (2025). Population of Metro City. https://metrokota.bps.go.id/id
2. Handayani, L., Putra, R., & Sari, D. (2020). Workload and occupational stress among health workers at community health centers. Jurnal Kesehatan Masyarakat, 16(1), 45-52. [in Indonesian]
3. Handayani, S., & Rahayu, D. (2019). Analysis of nurses’ workload using the NASA-TLX method in hospitals. Jurnal Kesehatan Masyarakat, 14(1), 35-42. [in Indonesian]
4. Hart, S. G., & Staveland, L. E. (1988). Development of NASA-TLX (Task Load Index): Results of empirical and theoretical research. Advances in Psychology, 52, 139-183.
5. Hidayat, M., Sari, Y., & Putri, R. (2021). Workload and occupational stress among hospital nurses. Jurnal Kesehatan, 12(3), 210-218. [in Indonesian]
6. Hobfoll, S. E. (1989). Conservation of resources: A new attempt at conceptualizing stress. American Psychologist, 44(3), 513-524. https://doi.org/10.1037/0003-066X.44.3.513
7. Karasek, R. A. (1979). Job demands, job decision latitude, and mental strain: Implications for job redesign. Administrative Science Quarterly, 24(2), 285-308.
8. Ministry of Health of the Republic of Indonesia. (2018). Basic Health Research 2018 (Riskesdas 2018). National Institute of Health Research and Development. [in Indonesian]
9. Ministry of Health of the Republic of Indonesia. (2023). Indonesia Health Profile 2023. [in Indonesian]
10. Ministry of Health of the Republic of Indonesia. (2024). Regulation of the Minister of Health of the Republic of Indonesia No. 19 of 2024 concerning community health centers. [in Indonesian]
11. Lai, J., Ma, S., Wang, Y., Cai, Z., Hu, J., Wei, N., Wu, J., Du, H., Chen, T., Li, R., Tan, H., Kang, L., Yao, L., Huang, M., Wang, H., Wang, G., Liu, Z., & Hu, S. (2020). Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Network Open, 3(3), e203976.
12. Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping. Springer Publishing Company.
13. Melyana, F., Pribadi, T., & Elliya, R. (2021). Prevalence and predictors of stress, anxiety, and depression among healthcare workers managing the COVID-19 pandemic in Bandar Lampung. Malahayati International Journal of Nursing and Health Science.
14. Priyatna, H., Mu’in, M., Naviati, E., & Sudarmiati, S. (2021). Anxiety and occupational stress among community health center workers during the COVID-19 pandemic. Holistic Nursing and Health Science, 4(2), 74-82. [in Indonesian]
15. Putri, A., Hidayati, S., & Ramadhan, F. (2020). Relationship between workload and anxiety among health workers at community health centers. Jurnal Ilmu Kesehatan, 8(2), 99-108. [in Indonesian]
16. Rachmawati, E., Sari, N., & Pratama, Y. (2021). Workload and depression among community health center nurses in Central Java. Jurnal Keperawatan Indonesia, 24(3), 210-218. [in Indonesian]
17. Saptono, A. A., Pramono, D., Wardani, N. D., & Wahyudi, F. (2022). Relationship of mental workload with stress and anxiety among health workers at community health centers in Makasar District, East Jakarta, during the COVID-19 pandemic (Undergraduate thesis). Universitas Diponegoro. [in Indonesian]
18. Schneider, J., Talamonti, D., Gibson, B., Forshaw, M., & Dewe, P. (2021). Workload and mental health outcomes in healthcare workers during the COVID-19 pandemic. BMC Public Health, 21, 1821.
19. Soemarko, D. S., Basrowi, R. W., Khoe, L. C., & Isbayuputra, M. (2022). Prevalence and determinant factors of health-worker burnout during the COVID-19 pandemic in Indonesia. Safety and Health at Work, 13, S211.
20. Spielberger, C. D. (2010). State-Trait Anxiety Inventory. Wiley Online Library.
21. Syafira, J. Z. (2024). Relationship of workload and rewards with burnout among nurses in the central surgical unit and inpatient wards of Jenderal Ahmad Yani Regional Hospital, Metro City (Undergraduate thesis). Poltekkes Kemenkes Tanjungkarang. [in Indonesian]
22. Tarwaka. (2015). Industrial ergonomics: Basic knowledge and workplace applications. Harapan Press. [in Indonesian]
23. Verdalena Hasan. (2024). Effects of job analysis and workload on employee productivity at the Metro City Health Office, Lampung (Master’s thesis). Universitas Muhammadiyah Metro. [in Indonesian]
24. World Health Organization. (2022). Mental health and working conditions of health workers: Policy brief. World Health Organization.