Psychological Distress, Social Stigma, Depression and Mental Health Crisis Among Nurses in High-Pressure Clinical Settings

Diah; Erfan Rofiqi; Septian Galuh Winata; Chlara Yunita Prabawati; Dzakiyatul Fahmi Mumtaz; Ken Siwi; Annisa Wigati Rozifa; Daviq Ayatulloh; Nursalam Nursalam

doi:10.30651/jkm.v11i2.32748

Penulis

Diah Department of Nursing, Faculty of Health Sciences, Universitas Muhammadiyah Surabaya, Indonesia
Erfan Rofiqi Department of Nursing, Faculty of Health Sciences, Universitas Muhammadiyah Surabaya, Indonesia
Septian Galuh Winata Department of Nursing, Faculty of Health Sciences, Universitas Muhammadiyah Surabaya, Indonesia
Chlara Yunita Prabawati Department of Nursing, Faculty of Health Sciences, Universitas Muhammadiyah Surabaya, Indonesia
Dzakiyatul Fahmi Mumtaz Department of Nursing, Faculty of Health Sciences, Universitas Muhammadiyah Surabaya, Indonesia
Ken Siwi Department of Physiotheraphy, Faculty of Health Sciences, Universitas Muhammadiyah Surabaya, Indonesia
Annisa Wigati Rozifa Department of Midwifery, Faculty of Health Sciences, Universitas Muhammadiyah Surabaya, Indonesia
Daviq Ayatulloh Department of Nursing, Faculty of Health Sciences, Universitas Gresik, Indonesia
Nursalam Nursalam Faculty of Nursing, Universitas Airlangga

DOI:

https://doi.org/10.30651/jkm.v11i2.32748

Kata Kunci:

Depression; high-pressure clinical settings; mental health crisis; nurses; psychological distress; social stigma

Abstrak

Background: Nurses working in high-pressure clinical settings are frequently exposed to heavy workloads, emotional demands, and challenging working environments that may compromise their psychological well-being. Persistent occupational stress, combined with negative societal perceptions and stigma toward healthcare professionals, may contribute to psychological distress, depression, and broader mental health crises among nurses. Understanding the relationship between psychological distress and social stigma is essential to identify factors contributing to mental health problems in nursing professionals. Methods: A cross-sectional study was conducted between June and October 2021 involving 2,156 nurses working in high-pressure clinical units across Indonesia. Data were collected using an online questionnaire consisting of sociodemographic characteristics, measures of psychological distress, and social stigma perceptions, along with a modified Depression, Anxiety, and Stress Scale (DASS-21). A researcher-developed mental health crisis scale was also used to assess severe psychological conditions. Data were analyzed using descriptive statistics, Chi-square tests, and Spearman’s rho correlation with a significance level of p < 0.05. Results: Most participants were aged 20–29 years (44.6%) and female (67.5%). Psychological distress was reported at moderate levels among 78.4% of respondents, while 18.5% experienced perceived social stigma. Severe depression was identified in 64.5% of nurses, and 63.5% reported severe mental health crisis conditions. Psychological distress and perceived social stigma were significantly associated with higher levels of depression and mental health crises among nurses (p < 0.05). Conclusion: Psychological distress and social stigma were significant factors associated with depression and mental health crises among nurses working in high-pressure clinical environments. These findings highlight the importance of implementing institutional mental health support systems, stigma reduction initiatives, and workplace interventions to protect nurses’ psychological well-being.

Referensi

Afshari, D., Nourollahi-Darabad, M., & Chinisaz, N. (2021). Demographic predictors of resilience among nurses during the COVID-19 pandemic. Work, 68(2), 297-303. https://doi.org/10.3233/wor-203376

Ali, R., Jawed, S., Baig, M., Azam Malik, A., Syed, F., & Rehman, R. (2021). General Public Perception of Social Media, Impact of COVID-19 Pandemic, and Related Misconceptions. Disaster Med Public Health Prep, 17, e23. https://doi.org/10.1017/dmp.2021.229

Amsalem, D., Dixon, L. B., & Neria, Y. (2021). The Coronavirus Disease 2019 (COVID-19) Outbreak and Mental Health: Current Risks and Recommended Actions. JAMA Psychiatry, 78(1), 9-10. https://doi.org/10.1001/jamapsychiatry.2020.1730

Bhanot, D., Singh, T., Verma, S. K., & Sharad, S. (2020). Stigma and Discrimination During COVID-19 Pandemic. Front Public Health, 8, 577018. https://doi.org/10.3389/fpubh.2020.577018

Blake, H., Bermingham, F., Johnson, G., & Tabner, A. (2020). Mitigating the Psychological Impact of COVID-19 on Healthcare Workers: A Digital Learning Package. Int J Environ Res Public Health, 17(9). https://doi.org/10.3390/ijerph17092997

Castellano-Tejedor, C., Torres-Serrano, M., & Cencerrado, A. (2022). Psychological impact in the time of COVID-19: A cross-sectional population survey study during confinement. J Health Psychol, 27(4), 974-989. https://doi.org/10.1177/1359105320985580

Cho, M., Kim, O., Pang, Y., Kim, B., Jeong, H., Lee, J., Jung, H., Jeong, S. Y., Park, H. Y., Choi, H., & Dan, H. (2021). Factors affecting frontline Korean nurses' mental health during the COVID-19 pandemic. Int Nurs Rev, 68(2), 256-265. https://doi.org/10.1111/inr.12679

Dong, Z. Q., Ma, J., Hao, Y. N., Shen, X. L., Liu, F., Gao, Y., & Zhang, L. (2020). The social psychological impact of the COVID-19 pandemic on medical staff in China: A cross-sectional study. Eur Psychiatry, 63(1), e65. https://doi.org/10.1192/j.eurpsy.2020.59

Dubey, S., Biswas, P., Ghosh, R., Chatterjee, S., Dubey, M. J., Chatterjee, S., Lahiri, D., & Lavie, C. J. (2020). Psychosocial impact of COVID-19. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 14(5), 779-788. https://doi.org/https://doi.org/10.1016/j.dsx.2020.05.035

Ebrahimi, H., Namdar, H., & Vahidi, M. (2012). Mental illness stigma among nurses in psychiatric wards of teaching hospitals in the north-west of Iran. Iran J Nurs Midwifery Res, 17(7), 534-538.

Galea, S., Merchant, R. M., & Lurie, N. (2020). The Mental Health Consequences of COVID-19 and Physical Distancing: The Need for Prevention and Early Intervention. JAMA Internal Medicine, 180(6), 817-818. https://doi.org/10.1001/jamainternmed.2020.1562

Galea, S., Merchant, R. M., & Lurie, N. (2020). The Mental Health Consequences of COVID-19 and Physical Distancing: The Need for Prevention and Early Intervention. JAMA Intern Med, 180(6), 817-818. https://doi.org/10.1001/jamainternmed.2020.1562

Golberstein, E., Wen, H., & Miller, B. F. (2020). Coronavirus Disease 2019 (COVID-19) and Mental Health for Children and Adolescents. JAMA Pediatr, 174(9), 819-820. https://doi.org/10.1001/jamapediatrics.2020.1456

Hu, D., Kong, Y., Li, W., Han, Q., Zhang, X., Zhu, L. X., Wan, S. W., Liu, Z., Shen, Q., Yang, J., He, H. G., & Zhu, J. (2020). Frontline nurses' burnout, anxiety, depression, and fear statuses and their associated factors during the COVID-19 outbreak in Wuhan, China: A large-scale cross-sectional study. EClinicalMedicine, 24, 100424. https://doi.org/10.1016/j.eclinm.2020.100424

Huang, L., Lei, W., Xu, F., Liu, H., & Yu, L. (2020). Emotional responses and coping strategies in nurses and nursing students during Covid-19 outbreak: A comparative study. Plos one, 15(8), e0237303. https://doi.org/10.1371/journal.pone.0237303

Huang, Q., Lei, S., & Ni, B. (2022). Perceived Information Overload and Unverified Information Sharing on WeChat Amid the COVID-19 Pandemic: A Moderated Mediation Model of Anxiety and Perceived Herd. Front Psychol, 13, 837820. https://doi.org/10.3389/fpsyg.2022.837820

Janoušková, M., Pekara, J., Kučera, M., Kearns, P. B., Šeblová, J., Wolfová, K., Kuklová, M., & Šeblová, D. (2024). Experiences of stigma, discrimination and violence and their impact on the mental health of health care workers during the COVID-19 pandemic. Sci Rep, 14(1), 10534. https://doi.org/10.1038/s41598-024-59700-5

Kang, L., Ma, S., Chen, M., Yang, J., Wang, Y., Li, R., Yao, L., Bai, H., Cai, Z., Xiang Yang, B., Hu, S., Zhang, K., Wang, G., Ma, C., & Liu, Z. (2020). Impact on mental health and perceptions of psychological care among medical and nursing staff in Wuhan during the 2019 novel coronavirus disease outbreak: A cross-sectional study. Brain Behav Immun, 87, 11-17. https://doi.org/10.1016/j.bbi.2020.03.028

Kassem, A. B., Ghoneim, A. I., Nounou, M. I., & El-Bassiouny, N. A. (2021). Community pharmacists’ needs, education, and readiness in facing COVID-19: Actions & recommendations in Egypt. International Journal of Clinical Practice, 75(11), e14762. https://doi.org/https://doi.org/10.1111/ijcp.14762

Lee, Y. R., Lee, J. Y., Park, I. H., Kim, M., Jhon, M., Kim, J. W., Ryu, S., Kim, J. M., & Kim, S. W. (2020). The Relationships among Media Usage Regarding COVID-19, Knowledge about Infection, and Anxiety: Structural Model Analysis. J Korean Med Sci, 35(48), e426. https://doi.org/10.3346/jkms.2020.35.e426

Liu, Z., Wu, J., Shi, X., Ma, Y., Ma, X., Teng, Z., You, X., Zhang, Y., Zhang, W., Feng, Z., Long, Q., Ma, X., Wang, L., & Zeng, Y. (2020). Mental Health Status of Healthcare Workers in China for COVID-19 Epidemic. Ann Glob Health, 86(1), 128. https://doi.org/10.5334/aogh.3005

Lopes, A. R., & Nihei, O. K. (2021). Depression, anxiety and stress symptoms in Brazilian university students during the COVID-19 pandemic: Predictors and association with life satisfaction, psychological well-being and coping strategies. PLoS One, 16(10), e0258493. https://doi.org/10.1371/journal.pone.0258493

Manik, M. J., Natalia, S., & Theresia. (2021). Social stigma towards nurses taking care of patients with COVID-19 in Indonesia: A mixed-methods study. Belitung Nurs J, 7(2), 98-106. https://doi.org/10.33546/bnj.1322

Marpaung, Y., Ernawati, E., & Fushen. (2024). Unmasking Stigma: A Qualitative Exploration of Nurses in Urban and Rural Indonesia during the COVID-19 Pandemic. The Open Nursing Journal, 18. https://doi.org/10.2174/0118744346313412240603062313

Maunder, R., Hunter, J., Vincent, L., Bennett, J., Peladeau, N., Leszcz, M., Sadavoy, J., Verhaeghe, L. M., Steinberg, R., & Mazzulli, T. (2003). The immediate psychological and occupational impact of the 2003 SARS outbreak in a teaching hospital. Cmaj, 168(10), 1245-1251.

McConnell, K. J., Edelstein, S., Wolk, C. B., Lindner, S., & Zhu, J. M. (2024). Differential impacts of the COVID-19 pandemic on mental health service access among Medicaid-enrolled individuals. Health Affairs Scholar, 2(9). https://doi.org/10.1093/haschl/qxae104

McConnell, K. J., Edelstein, S., Wolk, C. B., Lindner, S., & Zhu, J. M. (2024). Differential impacts of the COVID-19 pandemic on mental health service access among Medicaid-enrolled individuals. Health Affairs Scholar, 2(9), qxae104. https://doi.org/10.1093/haschl/qxae104

Moya, E., Larson, L. M., Stewart, R. C., Fisher, J., Mwangi, M. N., & Phiri, K. S. (2022). Reliability and validity of depression anxiety stress scale (DASS)-21 in screening for common mental disorders among postpartum women in Malawi. BMC Psychiatry, 22(1), 352. https://doi.org/10.1186/s12888-022-03994-0

Mustikasari, M., Fadhillah, H., Sunadi, A., Nursalam, N., Mediawati, A. S., & Adam, M. (2022). The Impact of COVID-19 on Psychological and Social Stigma for Indonesian Nurses: A Cross-Sectional Survey. Front Psychiatry, 13, 895788. https://doi.org/10.3389/fpsyt.2022.895788

Negarandeh, R., Shahmari, M., & Zare, L. (2024). Stigmatization experiences of healthcare workers in the context of the COVID-19 pandemic: a scoping review. BMC Health Serv Res, 24(1), 823. https://doi.org/10.1186/s12913-024-11300-9

Qiu, J., Shen, B., Zhao, M., Wang, Z., Xie, B., & Xu, Y. (2020). A nationwide survey of psychological distress among Chinese people in the COVID-19 epidemic: implications and policy recommendations. Gen Psychiatr, 33(2), e100213. https://doi.org/10.1136/gpsych-2020-100213

Salyer, S. J., Maeda, J., Sembuche, S., Kebede, Y., Tshangela, A., Moussif, M., Ihekweazu, C., Mayet, N., Abate, E., Ouma, A. O., & Nkengasong, J. (2021). The first and second waves of the COVID-19 pandemic in Africa: a cross-sectional study. Lancet, 397(10281), 1265-1275. https://doi.org/10.1016/s0140-6736(21)00632-2

Sampaio, F., Sequeira, C., & Teixeira, L. (2020). Nurses' Mental Health During the Covid-19 Outbreak: A Cross-Sectional Study. J Occup Environ Med, 62(10), 783-787. https://doi.org/10.1097/jom.0000000000001987

Sampaio, F., Sequeira, C., & Teixeira, L. (2021). Impact of COVID-19 outbreak on nurses' mental health: A prospective cohort study. Environ Res, 194, 110620. https://doi.org/10.1016/j.envres.2020.110620

Shiu, C., Chen, W. T., Hung, C. C., Huang, E. P., & Lee, T. S. (2022). COVID-19 stigma associates with burnout among healthcare providers: Evidence from Taiwanese physicians and nurses. J Formos Med Assoc, 121(8), 1384-1391. https://doi.org/10.1016/j.jfma.2021.09.022

Singhal, T. (2020). A Review of Coronavirus Disease-2019 (COVID-19). Indian J Pediatr, 87(4), 281-286. https://doi.org/10.1007/s12098-020-03263-6

Sutrisni, I. A., Kekalih, A., Friska, D., Timoria, D., Limato, R., Dien, R., Bogh, C., Chambers, M., Lewycka, S., & Van Nuil, J. I. (2023). Indonesian healthcare professionals’ experiences in rural and urban settings during the first wave of COVID-19: A qualitative study. Plos one, 18(7), e0288256.

Torales, J., O'Higgins, M., Castaldelli-Maia, J. M., & Ventriglio, A. (2020). The outbreak of COVID-19 coronavirus and its impact on global mental health. Int J Soc Psychiatry, 66(4), 317-320. https://doi.org/10.1177/0020764020915212

Trumello, C., Bramanti, S. M., Ballarotto, G., Candelori, C., Cerniglia, L., Cimino, S., Crudele, M., Lombardi, L., Pignataro, S., Viceconti, M. L., & Babore, A. (2020). Psychological Adjustment of Healthcare Workers in Italy during the COVID-19 Pandemic: Differences in Stress, Anxiety, Depression, Burnout, Secondary Trauma, and Compassion Satisfaction between Frontline and Non-Frontline Professionals. Int J Environ Res Public Health, 17(22). https://doi.org/10.3390/ijerph17228358

Wang, C., Pan, R., Wan, X., Tan, Y., Xu, L., Ho, C. S., & Ho, R. C. (2020). Immediate Psychological Responses and Associated Factors during the Initial Stage of the 2019 Coronavirus Disease (COVID-19) Epidemic among the General Population in China. Int J Environ Res Public Health, 17(5). https://doi.org/10.3390/ijerph17051729

Williams, R., & Drury, J. (2009). Psychosocial resilience and its influence on managing mass emergencies and disasters. Psychiatry MMC, 8, 293-296.

Yufika, A., Pratama, R., Anwar, S., Winardi, W., Librianty, N., Prashanti, N. A. P., Sari, T. N. W., Utomo, P. S., Dwiamelia, T., Natha, P. P. C., Salwiyadi, S., Asrizal, F. W., Ikram, I., Wulandari, I., Haryanto, S., Fenobilire, N., Wagner, A. L., Jamil, K. F., Mudatsir, M., & Harapan, H. (2022). Stigma Associated with COVID-19 Among Health Care Workers in Indonesia. Disaster Med Public Health Prep, 16(5), 1942-1946. https://doi.org/10.1017/dmp.2021.93