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Differences in Depression, Anxiety, and Stress Scores Across Workload Categories Among Nurses Working at Community Health Centers in Metro City, Lampung Province

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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.

Analysis of Patient Safety Culture among Healthcare Workers at Community Health Centers in Bandar Lampung, Indonesia

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This study aims to analyze the culture of patient safety among healthcare workers at Way Halim II Inpatient community health center, Satelit Inpatient community health center, and Pasar Ambon community health center in Bandar Lampung, Indonesia, in 2025. This cross-sectional survey used quantitative data that were collected through questionnaires distributed to all 200 healthcare workers using total sampling and analyzed with SPSS software. The research looks at 12 aspects of patient safety culture, such as how openly information is shared, how feedback and communication about mistakes happen, how often safety incidents are reported, how handoffs and transitions are managed, the support from management, responses that don’t punish mistakes, learning within the organization, views on patient safety, staffing levels, actions to promote safety, cooperation between different units, and cooperation within the same unit. The findings indicate that, overall, patient safety culture in the three community health centers is relatively good, particularly in staff support, cross-unit collaboration, and leadership openness. However, challenges remain, especially regarding low reporting rates for non-severe incidents, suboptimal non-punitive environments, and uneven information completeness during handoffs. Promoting inclusive leadership, strengthening teamwork, and fostering open communication are critical for enhancing patient safety practices. This study provides recommendations for policy development, capacity building, and future research directions to foster a sustainable, safety-oriented organizational culture in primary healthcare settings.