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

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.