Pattern and Sociodemographic Correlates of Job Stress among Staff in a Nigerian Psychiatric Hospital.

Context: Globalization and technological advances are associated with rapid social and economic changes which are accompanied by increased pressures in the work environment. Job stress is a hidden pandemic, especially in developing countries where it remains largely unaddressed. Aims: The objective is to determine the pattern and sociodemographic correlates of job stress among staff in a Nigerian psychiatric hospital using the Health and Safety Executive (HSE) indicator tool. Methods and Material: This is a cross-sectional study conducted among 292 full-time staff who were randomly selected across hospital units. Informed consent was obtained and the study questionnaires which included a sociodemographic questionnaire and the HSE indicator tool were administered. Statistical analysis was done using IBM SPSS version 22 and the level for statistical significance was set at P < 0.05.
Results: The study sample comprised of 133 (45.5%) men and 159 (54.5%) women. The mean age was 35.03 and (SD = 7.45). A high level of stress (<20th percentile) was found in the demands, control, and relationships domains. Sociodemographic correlates of stress in domain analysis included age, marital status, staff level, parenthood, and being a clinical worker. Conclusions: This study demonstrates a high level of stress in domains of the HSE indicator among respondents. More research is needed to further examine the stress levels of hospital workers. Copyright:

INTRODUCTION

Job stress has been defined as a harmful physical or psychological response that occurs when the demands of work do not match the individual's resources, needs, or capacity.[1] It is the product of interactions with aspects of the work environment that are perceived to be physically, emotionally, or morally threatening.[2] Generally, the characteristics of the individual, as well as those of the environment are important in understanding the mechanisms of stress.

The Health and Safety Executive (HSE), which is the health and safety division of the UK government, has identified six core areas of work stress and adopted management standards for dealing with them.[3] These are the demands, control, support, role, change, and relationship domains. Demand is determined by the workload, work environment, and work pattern; control is the extent to which a person has a say in how they do their work; support includes the assistance and resources provided by both peers and management to help workers do their jobs; relationships are about positive relationships and conflict on the job; role concerns the extent to which people understand their roles in the organization; and change concerns how adjustments in the organization are managed and communicated to the staff. The HSE recommends the use of its indicator tool to assess employees in these domains and recommends its management standards for addressing workplace stress.

Hospital workers are known to experience a significant level of job stress and it is reported to be on the rise.[4] When present, it can have a wide-ranging impact on the performance of the worker and their well-being. Stressed hospital workers have higher levels of anxiety and depression, commit more medical errors, and have poorer job output, all of which impact organizational performance.[5] Although some local studies on job stress among hospital workers have been conducted previously, the HSE indicator tool, considering its unique advantages, has never been used among health workers in a Nigerian population. Our study aims to determine the level of job stress and its sociodemographic correlates using the HSE indicator tool in a Nigerian psychiatric hospital.

METHODS

This is a cross-sectional study conducted among the staff of the Federal Neuropsychiatric Hospital, Calabar. It has two major departments: the Clinical Department and the Administration Department. Both departments have subunits that serve important functions to the operations of the hospital, with a combined total of over 1000 staff.

Permission to conduct the study was obtained from the Research and Ethics committee of the Federal Neuropsychiatric Hospital, Calabar. Written informed consent was obtained from each study participant, and confidentiality, as well as anonymity, was assured.

A formula using a known proportion was applied to calculate the sample size.[6] Using the desired precision of 5%, a 95% confidence level and a prevalence of 77.4% from a previous study, a sample size of 272 was estimated.[7] This was adjusted by 15% to compensate for possible nonresponse to give a final estimated sample size of 312.

A list of all staff in the hospital was obtained from the personnel department. From this list, a table of random numbers was used to select 312 staff that would be approached for recruitment. Ten trained research assistants approached selected staff for questionnaire administration. They explained the study objectives and obtained written consent before administering the study questionnaire. Data collection lasted two weeks.

Study measures

The HSE indicator tool, also known as the Management Standards Indicator Tool, is a 35-item self-report questionnaire that allows organizations to assess stress in seven domains.[3] The tool has been used across different sociocultural contexts including Nigeria.[89]

Data analysis

Study data were analyzed using the IBM SPSS software version 21. The sociodemographic characteristics, as well as the pattern of job stress in its six dimensions, were determined and presented as descriptive data. Associations between job stress and sociodemographic characteristics were determined using bivariate analysis. The level of statistical significance was set at 0.05 (two-tailed).

RESULTS

Among the 312 workers who were approached for recruitment, 13 did not consent to participate while 7 returned incompletely filled questionnaires. This brought the total number recruited to 292. In the study sample, there was a higher representation of females, clinical staff, and those with tertiary education. Further details are displayed in Table 1.

Table 1

Sociodemographic characteristics of respondents

Variable	Frequency n=292	Percentage (100%)
Age (years)
18-25	29	9.9
26-30	60	20.5
31-35	68	23.3
34-40	77	26.4
41-45	38	13.0
46 and above	20	6.8
MEAN (SD)	35.03 (7.45)
Gender
Male	133	45.5
Female	159	54.5
Department
Clinical	160	54.8
Nonclinical	132	45.2
Grade Level
Junior	93	31.8
Senior	199	68.2
Marital status
Married	171	58.6
Not yet married	102	34.9
Separated or divorced	16	5.5
Widow or Widower	3	1.0
Educational Status
Primary	8	2.7
Secondary	44	15.1
Tertiary and above	240	82.2
Number of children
No child	110	37.7
1-2	101	34.6
3-4	55	18.8
>4	26	8.9
Years as a worker in Hospital
1-5	149	51.0
6-10	99	33.9
11-15	14	4.8
Above 15	30	10.3
Total number of work years (includes prior jobs)
1-5	99	33.9
6-10	110	37.7
11-15	39	13.4
Above 15	44	15.1

Table 2 shows the prevalence of job stress, ranging from high, moderately high, moderately low to low in each of the domains of the HSE indicator tool. A majority of the sample had high levels of stress in the demands, control, peer support, and relationships domains, with a prevalence ranging from 49.7% to as high as 92.5%.

Table 2

Frequency of job stress in each domain among respondents

Domains	Red (high) n (%) <20th percentile	Yellow (moderately high) n (%) ≥20th & <50th percentile	Aqua (moderately low) n (%) ≥50th & <80th percentile	Green (low) n (%) ≥80th percentile
Demands	187 (64.0)	26 (8.9)	41 (14.0)	38 (13.0)
Control	202 (69.2)	29 (9.9)	29 (9.9)	32 (11.0)
Managers’ support	105 (36.0)	30 (10.3)	25 (8.6)	132 (45.2)
Peer support	145 (49.7)	42 (14.4)	None	105 (36.0)
Relationship	270 (92.5)	13 (4.5)	8 (2.7)	1 (0.3)
Role	105 (36.0)	None	32 (11.0)	155 (53.1)
Change	97 (33.3)	55 (18.8)	None	140 (47.9)

Among the seven domains of job stress [Table 3], the average scores in demands, control, and relationships fell below the 20th percentile, indicating a high level of job stress in these areas with urgent action needed. Peer support was above the 20th percentile but less than the 60th percentile, indicating that improvement was needed. All other domains (manager support, role, and change) were above the 60th percentile but below the 80th percentile, suggesting that there was a good performance in these areas but with potential for improvement.

Table 3

Mean score in each domain for all respondents

Variable	Mean	95% Confidence Interval	Level	Interpretation
Demand	2.73	2.66-2.79	<20th percentile	Urgent action required
Control	2.84	2.76-2.92	<20th percentile	Urgent action required
Peer support	3.64	3.56-3.72	>20th but <50th percentile	Improvement needed
Manager support	3.51	3.43-3.59	>50th but <80th percentile	Good performance but potential improvement
Relationships	2.62	2.55-2.69	<20th percentile	Urgent action required
Role	4.24	4.16-4.42	>50th but <80th percentile	Good performance but potential improvement
Change	3.17	3.08-3.26	>50th but <80th percentile	Good performance but potential improvement

Table 4 shows the relationship between each domain of job stress and sociodemographic characteristics. Being 35 years old or less was significantly associated with higher scores in the demand, control, relationships, and change domains. Also, being a senior staff member was significantly associated with higher scores in the demand and control domains. Respondents who were not married had higher scores in the control and relationships domains. Furthermore, not having children was associated with higher scores in the relationship domain while being a clinical staff was associated with higher scores in the demand and control domains. Other bivariate comparisons were not statistically significant.

Table 4

Relationship between job stress and sociodemographic characteristics

Variable	Demand	Control	Peer support	Manager support	Relationships	Role	Change
Age (years)
18-35	2.79	2.95	3.63	3.49	2.70	4.27	3.27
Above 35	2.65	2.71	3.65	3.53	2.52	4.21	3.05
	P=0.03*	P=0.002*	P=0.78	P=0.63	P=0.01*	P=0.48	P=0.01*
Gender
Male	2.74	2.86	3.63	3.53	2.55	4.27	3.17
Female	2.72	2.82	3.65	3.49	2.68	4.21	3.17
	P=0.74	P=0.58	P=0.85	P=0.58	P=0.06	P=0.48	P=0.95
Grade Level
Junior	2.61	2.69	3.69	3.53	2.61	4.27	3.17
Senior	2.78	2.91	3.62	3.50	2.62	4.23	3.17
	P=0.01*	P=0.007*	P=0.47	P=0.67	P=0.85	P=0.67	P=0.95
Current Marital status
Married	2.69	2.77	3.61	3.48	2.55	4.22	3.14
Not Married	2.78	2.94	3.69	3.54	2.72	4.27	3.21
	P=0.19	P=0.02*	P=0.34	P=0.45	P=0.02*	P=0.55	P=0.45
Educational Status
Secondary or less	2.74	2.82	3.61	3.53	2.67	4.17	3.15
Tertiary	2.73	2.84	3.65	3.50	2.61	4.26	3.17
	P=0.86	P=0.83	P=0.71	P=0.78	P=0.53	P=0.44	P=0.84
Have Children
No	2.78	2.93	3.69	3.43	2.71	4.25	3.11
Yes	2.70	2.79	3.61	3.55	2.56	4.24	3.21
	P=0.24	P=0.09	P=0.36	P=0.15	P=0.04*	P=0.91	P=0.30
Years in Hospital
1-5	2.70	2.84	3.68	3.51	2.64	4.21	3.23
More than 5	2.75	2.84	3.60	3.50	2.60	4.27	3.10
	P=0.47	P=0.91	P=0.35	P=0.88	P=0.62	P=0.42	P=0.16
Dept.
Clinical	2.79	2.91	3.61	3.50	2.65	4.19	3.18
Nonclinical	2.65	2.75	3.69	3.52	2.59	4.30	3.16
	P=0.03*	P=0.04*	P=0.33	P=0.79	P=0.44	P=0.17	P=0.85

*P<0.05 is statistically significant

DISCUSSION

In this study, we found a high level of job stress requiring intervention in the demands, control, and relationships domains of the HSE indicator tool. In none of the domains of this instrument was the performance within the ideal state, which should be above the 80th percentile. Furthermore, we found some correlations between the sociodemographic characteristics of study respondents and job stress. Age, marital status, staff level, parenthood, and being a clinical worker were all significantly associated with dimensions of job stress.

Although the HSE indicator tool was developed in the UK for the assessment of job stress, it has found application across continents.[101112] In Nigeria, its use is scarce and to the best of our knowledge, it has not been used among hospital workers. Globally, the use of this instrument in research among hospital workers is also sparse but there are a few reports in Europe. In one study by Ike et al.,[13] none of the domains showed a high level of stress (that is, below the 20th percentile). In addition, moderately high stress was found in the control and role domains (that is, above the 20th percentile but below the 50th percentile). In another UK study, only the role domain had high stress while the control and relationships domains had moderately high stress.[14] High stress in the relationships and changes domain was found in an Italian study, followed by moderately high stress in the manager and peer support domains.[15] In our study, high stress was noted in three domains (demand, control and peer support), while stress in the relationships domain was moderate. Compared to the others, our study reports more domains with a high level of stress, suggesting that hospital workers in our sample experience more job stress than their counterparts in Europe. This could be explained by differences in work conditions and other socioeconomic realities across countries. For example, the other studies were in developed nations, unlike Nigeria.

In our study, the domains with the poorest performance were demand, control, and relationships while the best performance was in manager support, role and change. As seen in a review of 13 studies that assessed organizations using the HSE, there is no clear trend in terms of what domains are predominantly low or high across organizations.[8] This implies that the performance might vary from one organization to another, depending on work culture, job environment, and other peculiarities in each context.

We found that younger workers had more stress compared to older workers. According to previous reports, findings in this regard are mixed.[16] The evidence tends to tilt more in favor of our report and several explanations have been proposed.[1617] Some suggest that older workers occupy more strategic or managerial positions which are associated with less stress due to task delegation. Also, they have better, more stable, and more meaningful social relationships, have families which are more settled, etc.[1617] It is worth noting that in our study, senior staff had more job stress in the demand and control domains. Perhaps further studies will be useful to clarify these relationships.

Unmarried respondents had higher job stress in the control and relationships domains. This is in keeping with previous research which suggests that unmarried workers have higher levels of stress compared to those who are married.[1819] It has been suggested that marital relationships may be a source of social support, reducing the risk for burnout.[20] Having children, which is more likely among people who are married, has also been shown to be a protective factor.[21] The latter is also in keeping with our report, as we found in our study, as we found higher stress among persons without children. Also, in some cultural contexts, people who are married have better social integration and acceptance into the community and this might play a role.[22]

Among clinical staff, stress was higher in the demands and control domains compared to non-clinical staff. This was in keeping with another study in a Nigerian psychiatric hospital which found higher levels of job stress among clinical workers compared to non-clinical workers.[7] Several factors could explain this finding. For example, clinicians and other health workers connect emotionally with their patients, emotionally with their patients, which improves outcomes.[23] This emotional demand is a source of additional stress which is largely absent from non-clinical work. In addition, the health system in Nigeria is ill-equipped, understaffed, and underfunded, which has led to frequent strikes and a mass exodus of health workers from the country thereby further increasing the workload.[2425] These stressors are somewhat unique to clinical staff and could add to their levels of stress.

CONCLUSION

We sought to determine the pattern and sociodemographic correlates of job stress among the staff of the Federal Neuropsychiatric Hospital, Calabar, using the HSE indicator tool. We found a high level of job stress in the demand, control, and relationships domains of the tool which suggests that these areas require urgent intervention to ameliorate stress. Sociodemographic correlates of stress in domain analysis included age, marital status, staff level, parenthood, and being a clinical worker. In conclusion, our sample had a high level of stress, with less-than-ideal performance in all domains of the HSE indicator tool.

Organizations should become more sensitive to job stress among employees. It would be helpful to design or adapt preventive interventions targeted at subgroups with a higher risk. Also, regular checkups among workers are needed, and when present, managing stress is essential. The advantage of the HSE indicator tool is that it comes with a step-by-step workbook offering a systematic approach to stress management. This workbook or other validated stress management approaches would reduce stress, improve occupational health and related outcomes such as job output and satisfaction. Also, governments should pay more attention to job stress. Legislation targeted at employers of labor, public health programs and policies on job stress would go a long way to protect workers and foster well-being at work.

Limitations

Our study has some limitations which should be borne in mind. First, we used self-assessment which could lead to reporting bias. Also, the HSE indicator tool, while very useful, has not been used much in Nigeria, and this limits comparisons. Standardization of this tool might be needed to make it more applicable in Nigerian populations. Thirdly, while our study was able to determine some correlates of work stress, it cannot make any claims about causality. Lastly, our study was conducted in a government-owned specialist psychiatric hospital located in an urban area. This might limit the generalizability of findings to other settings such as private organizations or those in rural areas.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.