Work-related stress is a significant concern, with the World Health Organization (WHO) defining it as the response individuals experience when faced with demands and pressures that exceed their knowledge, abilities, or coping capacities. Stress is common in many work environments, particularly when employees feel unsupported by supervisors or colleagues and have little control over their work processes. Although some degree of pressure can motivate employees and improve performance, excessive or unmanageable pressure can lead to stress, adversely affecting both employee health and organizational performance. Key contributors to work-related stress include poor job design, ineffective management, unsatisfactory working conditions, and a lack of support from coworkers or supervisors. Research shows that jobs with excessive demands, minimal control, and inadequate support are the most stressful. Globally, approximately 50–70% of HCWs report some degree of stress during their careers, and chronic exposure has been linked with adverse physical manifestations such as cardiovascular strain, musculoskeletal pain, and sleep disturbances. The psychological burden includes anxiety, depressive symptoms, and increased risk of substance misuse. In India, the healthcare system faces unique challenges—high patient-to-staff ratios, insufficient infrastructure, and prolonged working hours contribute to sustained stress levels among HCWs. In regions like Jammu & Kashmir, these challenges are magnified by geographic constraints, episodic surges in patient load, and resource limitations. Despite these challenges, few structured studies have systematically evaluated occupational stress among HCWs in this region. This study was undertaken to address this gap by assessing the prevalence, severity, and manifestations of stress among HCWs at GMC Anantnag and to generate evidence for policy and institutional reforms. Aims and objectives: 1. To assess the stress level among the healthcare workers at GMC Anantnag. 2. To assess the stress impact on health. Hypothesis: There is a significant relationship regarding the stress level and health of health care workers of GMC Anantnag.

The present cross-sectional and questionnaire- based survey was conducted among healthcare workers working at Government Medical College Anantnag. The participants had been asked to complete a pre-tested and pre-designed questionnaire that includes a list of sources of stress. The pretested, predesigned, semi-structured questionnaire consisted of 3 parts: Part 1: Socio-demographic characteristics like age, sex, socio-economic status etc. Part 2: Kessler psychological distress scale (K10) Psychological Distress Scale. We used the Kessler10 Psychological Distress instrument (K10) developed by Kessler and colleagues.6 k-10 consists of 10 items on scale and each item is having responses which scores from1-5. All the questions had been collated to obtain a total score. The total score was interpreted as follows: a score of less than 20 was considered not to represent stress of any level while a score of 20-24 represented mild stress, 25-29 represented moderate stress, and 30-50 represented severe stress7. Part 4: Patient Health Questionnaire Physical Symptoms (PHQ-15): had been used to assess the somatic symptoms due to stress. This scale consisted of 15 items and each item was having three responses of not bothered at all, bothered a little and Bothered a lot which were scored as 0,1 and 2 respectively. The total score was interpreted as per the score interpretation which is given below the scale. Sample size: All the healthcare workers of GMC Anantnag who meet the inclusion criteria were included in the study. Inclusion Criteria: • All the health care workers of GMC Anantnag. • Who were available at the time of data collection? • Who gave consent to participate. Exclusion Criteria: •Healthcare workers with a history of psychiatric illness. • HCWs with a history of treatment for any psychiatric illness at present. Collection of data The questionnaire along with the consent form was administered to the subjects in the month of April and data was collected within three months through google form and the link was shared to the HCWs in a what’s app group, email. The HCWs were allowed to respond in their own time and privacy. The participation was entirely voluntary. EthicalConsiderations: Approval was obtained from the Institutional Ethics Committee, GMC Anantnag. Data Analysis: Data was entered in Microsoft Excel and analysed using the SPSS software (version 16.0). The outcome variable—stress—had been categorized dichotomously as stress (no/yes). The three levels (mild, moderate, and severe) of stress had been put into one category and titled as ‘presence of stress’. Descriptive statistics (mean, standard deviation, and percentages) was used for summarizing the study and outcome variables. Pearson's chi-square test for trend and odds ratios had been used for observing and quantifying the association between a categorical outcome (i.e. the stress level) and different study variables.

Table 1: Prevalence of Stress (K10 Scale) STRESS LEVEL NUMBER (N=200) PERCENTAGE (%) No Stress 85 42.5 Mild Stress 85 42.5 Moderate Stress 15 7.7 Severe Stress 15 7.5 Total with Stress (Mild–Severe) 115 57.5 More than half of healthcare workers (57.5%) experienced stress, with mild stress being the most common. Table 2: Demographic Profile and Stress Correlation VARIABLE CATEGORY PERCENTAGE (%) STRESS OBSERVED (%) Age Group 30–39 years 41.4 High prevalence 40–49 years 27.4 Moderate prevalence >50 years 9.3 Low prevalence Gender Male 63.7 Similar to females Female 29.3 Comparable Experience ≥10 years 43.3 Higher stress levels <10 years 42.8 Moderate levels Working Hours >50 hours/week 26.5 Increased stress Staffing Adequacy Inadequate 72.6 High correlation Agroup 30–39, long working hours, and inadequate staffing were strongly associated with stress. Table 3. Major Workplace Stressors STRESSOR PERCENTAGE (%) Inadequate staffing 72.6 Documentation workload 70.7 Lack of workplace support 58.1 Extra night/weekend duties 33.9 No compensation for extra hours 62.8 Organizational factors were the predominant causes of stress. Table 4. Psychological Symptoms (K10) SYMPTOM MOST OF THE TIME (%) ALL THE TIME (%) Nervousness 18.6 4.7 Hopelessness 12.8 6.5 Restlessness 14.0 6.5 Feeling worthless 9.8 4.5 Nervousness and hopelessness were the most common psychological manifestations. Table 5: Physical Symptoms (PHQ-15) SYMPTOM MOST OF THE TIME (%) ALL THE TIME (%) Backache 53.5 10.0 Heart racing/palpitations 37.5 22.5 Tiredness/fatigue 54.0 14.0 Sleep disturbances 22.0 7.5 Headache Rare/Never: 72 – Backache and palpitations were highly prevalent, indicating a substantial physical stress burden. Table 6. Summary of Analysis DOMAIN OBSERVATION Prevalence 57.5% of HCWs had some level of stress Severity Mostly mild; 15.2% moderate–severe Demographics Higher stress among age 30–39 & ≥10 years’ experience Main Stressors Staffing shortage, workload, administrative tasks Physical Impact Backache, palpitations, tiredness Psychological Impact Nervousness, hopelessness, worthlessness

This study aimed to assess the levels of stress among healthcare workers (HCWs) at GMC Anantnag, exploring the potential factors contributing to their stress and the implications for workplace well-being. The results reveal a multifaceted profile of stress and its related symptoms, aligning with findings from other similar studies in healthcare settings. Stress Levels Among HCWs The study found that 42.5% of participants experienced mild stress, 7.7% moderate stress, and 7.5% severe stress. These findings are consistent with previous research that highlights the high prevalence of stress among healthcare professionals. For instance, in a study conducted by Adriaenssens et al. (2015), 38% of nurses reported high stress levels, driven by workload, emotional demands, and lack of support. Similarly, another study by Moustaka and Constantinidis (2010) indicated that approximately 50% of healthcare workers exhibited mild to moderate stress, particularly due to administrative burden and staff shortages. This aligns with global research indicating that healthcare professionals are at high risk of stress and burnout. For example, a cross-sectional study conducted in Egypt by Elshaer et al. (2018) revealed that 33.6% of healthcare workers experienced high levels of stress, particularly those in direct patient care roles, similar to the rates observed in our study. Elshaer’s research also highlighted that stress levels were linked to factors like job demand, shift work, and lack of administrative support. Similarly, in a meta-analysis conducted by Giorgi et al. (2020) involving healthcare workers across 15 countries, it was found that stress prevalence rates ranged from 25% to 67%, with the highest rates observed among nurses and physicians working in high-pressure environments like emergency rooms and intensive care units (ICUs). These findings are comparable to our study, where a substantial percentage of HCWs reported stress, particularly due to the burden of working long hours and inadequate staffing. The findings from this study provide valuable insights into the distribution of stress levels among the population. Of the 200 study participants, 42.5% reported no stress, while an equal proportion of 42.5% experienced mild stress. A smaller percentage of 7.7% had moderate stress, and 7.5% experienced severe stress. These results align with findings from several previous studies. Physical Symptoms of Stress Our study shows that 53.5% of HCWs reported back pain as a frequent physical symptom, which aligns with research on the musculoskeletal impact of stress in healthcare professionals. For instance, a study by Trinkoff et al. (2006) found that nurses and other HCWs were more prone to physical ailments such as back pain and arm pain due to the physical demands of their work, such as lifting patients and standing for long periods. The prevalence of back pain, neck pain, and other musculoskeletal disorders in healthcare professionals has been well documented in both national and international studies. Moreover, the relationship between physical pain and psychological distress has been explored in various studies. According to a study by Caruso et al. (2004), healthcare workers who experienced higher levels of occupational stress were more likely to report physical symptoms like headaches, muscle tension, and fatigue, further corroborating our findings. This underscores the connection between the high-pressure environment and the physical toll it takes on HCWs. Psychological Symptoms and Emotional Distress Psychological symptoms such as anxiety, hopelessness, and nervousness were also prevalent in our study. We found that 22.3% of HCWs reported feeling nervous some of the time, while 18.6% reported nervousness most of the time. This is consistent with the findings of a study by Wu et al. (2020), where 24% of healthcare workers in China experienced moderate to severe anxiety during the COVID-19 pandemic. Although our study predates the pandemic, the levels of anxiety reported are similar to those observed during periods of high healthcare demand, indicating that chronic stress in healthcare is not an isolated occurrence but a persistent issue. Additionally, feelings of hopelessness, as reported by 46% of our participants, mirror the emotional exhaustion and burnout identified in other studies. A landmark study by Maslach et al. (2001) emphasized that emotional exhaustion is a key dimension of burnout, particularly in healthcare settings. Emotional exhaustion, which often manifests as feelings of hopelessness, is a common consequence of prolonged stress. The high prevalence of this symptom in our study reflects the global concern regarding mental health among HCWs. Workplace Stressors Our study identified key workplace stressors such as long working hours, night shifts, and inadequate staffing. Specifically, 38.1% of respondents worked more than 40 hours per week, and 72.6% indicated that inadequate staffing contributed to their stress levels. These results are supported by a study conducted by Aiken et al. (2002), which found that higher nurse-to-patient ratios were associated with increased burnout and job dissatisfaction. Aiken’s study emphasized that inadequate staffing levels in hospitals not only contribute to stress but also negatively impact patient outcomes . Furthermore, a study by Stone et al. (2007) found that healthcare workers who worked more than 50 hours a week were more likely to experience burnout, depression, and other psychological issues. Our findings, with 26.5% of HCWs working more than 50 hours per week, similarly show that excessive work hours are a major contributor to occupational stress . The cumulative effect of long hours, demanding shifts, and the emotional toll of patient care has been widely recognized as a leading cause of stress in the healthcare profession. Role of Night Shifts and Weekend Work In our study, 32.1% of participants reported working night shifts sometimes, and 10.2% worked night shifts all the time. Research has shown that night shifts and irregular work schedules significantly contribute to occupational stress. According to a study by Geiger-Brown and Trinkoff (2010), night shift workers in healthcare experience greater disruption to their circadian rhythms, which leads to sleep disturbances, increased fatigue, and a higher risk of developing chronic stress. Weekend work was also identified as a stressor, with 32.1% of participants working weekends all the time and 27.9% sometimes. These findings are supported by research conducted by Estryn-Behar et al. (2011), which found that healthcare workers who frequently worked weekends reported higher stress levels and lower job satisfaction compared to those who had regular days off. Workplace Support and Coping Mechanisms Despite the high levels of stress, only 41.9% of participants in our study reported having access to workplace support for stress relief. This finding highlights a gap in institutional support for HCWs. The importance of workplace support systems in mitigating stress has been emphasized in several studies. For instance, a study by Mealer et al. (2012) found that ICU nurses who had access to peer support programs and resilience training reported lower levels of stress and burnout. Similarly, West et al. (2016) suggested that workplace interventions, such as mindfulness-based stress reduction (MBSR) programs and resilience training, can significantly reduce stress and improve mental health outcomes among healthcare professionals. Our study also found that 64.7% of participants were exposed to stress outside of work, which further exacerbates their workplace stress. This finding is consistent with research by Linzer et al. (2009), who found that stress from personal life often intersects with professional stress, leading to a cumulative effect that can worsen burnout. Limitations: The cross-sectional design precludes causality inference. Data were self-reported, which may introduce bias. The single-institution scope limits generalizability, but the study provides a crucial baseline for the region.

The results of this study underscore the pervasive nature of stress among healthcare workers at GMC Anantnag, with findings that are consistent with broader global trends. The high levels of both physical and psychological symptoms of stress point to the need for targeted interventions, such as improved staffing, reduced working hours, and enhanced workplace support. By addressing these systemic issues, healthcare institutions can better support their workers, reduce stress, and ultimately improve patient care. Further research is needed to explore the long-term impact of stress on HCWs and to develop more effective coping strategies tailored to the unique demands of healthcare professionals. A study by Cohen et al. (1983) on the perceived stress scale (PSS) indicated that stress is prevalent in the general population, with the majority experiencing mild to moderate levels of stress, similar to our findings where the largest proportions fell into the no-stress or mild stress categories. Cohen’s work has been widely used to measure stress levels across different populations, reinforcing the idea that stress affects individuals differently, with the majority experiencing manageable levels but a notable minority experiencing more severe effects. Similarly, a cross-sectional study by Shukla et al. (2018) on stress in the Indian population found that 45% of the population reported mild stress, while only 8% experienced severe stress. These results are strikingly similar to our study, where mild stress was also the most common, and the percentage of severe stress closely matched Shukla et al.'s findings. Their research highlighted the role of urbanization, lifestyle changes, and work-related pressures as significant contributors to mild stress in the population, a factor that may also explain the high prevalence of mild stress in our study. Moreover, research by Lazarus and Folkman (1984) introduced the concept of stress appraisal and coping, which plays a critical role in how individuals perceive and manage stress. In their findings, the authors suggested that the majority of people tend to experience low to moderate stress because they employ effective coping mechanisms, which may explain why 42.5% of our participants reported no stress and another 42.5% had only mild stress. This supports the theory that coping strategies such as social support, problem-solving, and emotional regulation may buffer the impact of stress, preventing it from progressing to more severe levels. A study by Roberts et al. (2014) on workplace stress found that 9% of employees experienced severe stress, closely mirroring the 7.5% reported in our study. Roberts’ study also highlighted the need for targeted interventions, especially for individuals experiencing severe stress, as these participants were more likely to report higher rates of absenteeism, burnout, and health complications. Our findings align with this perspective, underscoring the necessity for immediate intervention for those experiencing severe stress, such as counseling, cognitive behavioral therapy, and lifestyle modifications to mitigate the potential long-term health impacts. The relatively smaller percentage of subjects experiencing moderate and severe stress (7.7% and 7.5%, respectively) is consistent with the research conducted by Kessler et al. (2005), who found that severe stress and related mental health disorders affect only a small but significant proportion of the population. In their study, stress was strongly correlated with various psychiatric conditions, such as depression and anxiety, which may develop or worsen in individuals experiencing moderate to severe stress. In conclusion, the distribution of stress levels in this study is consistent with findings from other studies, such as those by Cohen et al. (1983), Shukla et al. (2018), Lazarus and Folkman (1984), Roberts et al. (2014), and Kessler et al. (2005). While a large proportion of the population experiences no or mild stress, there remains a significant subset who experience moderate to severe stress, necessitating targeted interventions. Further research should focus on identifying the specific stressors contributing to these stress levels and exploring more effective strategies for prevention and management. This study offers a comprehensive examination of stress levels among healthcare workers (HCWs) at GMC Anantnag and highlights the significant occupational and psychological stressors impacting this group. The findings reveal that a considerable proportion of HCWs experience mild to severe stress, with a notable prevalence of physical symptoms such as back pain and psychological issues including nervousness, hopelessness, and burnout.

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