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APP| Published By AEIRC| https://doi.org/10.29052/2412-3188.v6.i1.2019.23-29 

ISSN 2412 - 3188 

Original Article                                                                                  

Prevalence of depression, anxiety and stress 
among healthcare professionals at tertiary 
care hospitals, Karachi – Pakistan 
Yameema Ayub, Raheel Anjum, Shabana Margrat,  
Azeem Ashraf & Saira Qayyum 
St. James Institute of Nursing and Health Science  

 

Abstract 
Background: The prevalence and severity of mental health issues among the 
healthcare professionals (HPs) has escalated during the past few years. 
Depression, anxiety and stress are common complaints among the HP’s, having a 
profound impact on their personal and professional life. The purpose of this study 
was to assess the severity level of depression, anxiety and stress among HPs at 
tertiary care hospitals of Karachi. 
Methodology: A cross-sectional study was conducted from May to July 2019 at 
three tertiary care teaching hospitals of Karachi including Jinnah Post Graduate 
Medical Centre (JPMC), National Institute of Child Health (NICH) and National 
Institute of Cardiovascular Diseases (NICVD). Total 260 HPs (doctors, nurses, 
physiotherapist, pharmacist, laboratory technician and nursing technicians) were 
selected through convenience sampling method. In addition to the demographic 
details, the prevalence and severity score of depression, anxiety and stress was 
assessed using depression, anxiety and stress scale 42 (DASS 42). The collected 
data was analyzed using SPSS version 23. 
Results: Among 260 HP’s, 48.5% were males and 51.5% were females, moderate 
depression was found in 33(12.7%) HP’s, 28(10.8%) had severe depression while 
6(2.3%) were suffering from extremely severe depression. Anxiety levels were 
moderate in 67(25.8%), 32(12.3%) and 21(8.1%) reported severe and very severe 
anxiety respectively. Moreover, stress levels were moderate among 45(17.3%) 
HP’s, while severe and very severe levels were observed among 13(5%) and 
7(2.7%) responders respectively. There was no association in between the 
sociodemographic characteristics and depression, anxiety and stress (p>0.05). 
Conclusion: It was observed that most of the HP’s were suffering from mild to 
moderate depression, anxiety and stress. Further research is required to explore 
the possible contributing factors and methods for eradication of this health issue. 
 

Keywords 
Depression, Anxiety, Stress, DASS 42, Healthcare Professionals.  

Citation: Ayub Y, Anjum R, Margrat S, 
Emmanual A, Ashraf A, Qayyum S. 
Prevalence of depression, anxiety and 
stress among healthcare professionals 
at tertiary care hospital, Karachi – 
Pakistan. APP. 2019; 6(1):23-29 
 
Corresponding Author Email: 
ymmy_ayub@yahoo.com 
 
DOI: 10.29052/2412-3188.v6.i1.2019.23-29 

 
Received 11/08/2019 
 
Accepted 03/10/2019 
 
Published 12/10/2019 
 
Copyright © The Author(s). 2019 This  
is an open access article distributed 
under the terms of the Creative 
Commons Attribution 4.0 International 
License, which permits unrestricted 
use, distribution, and reproduction in 
any medium, provided the original 
author and source are credited.  
 

 

Funding: The author(s) received no 
specific funding for this work. 

Conflicts of Interests: The authors 
have declared that no competing 
interests exist. 
 

https://doi.org/10.29052/2412-3188.v6.i1.2019.
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APP| Published By AEIRC| Volume 6 Issue 1  

 

Introduction  
Highly prevailing mental health condition of 
the era, depression along with anxiety and 
stress have become the major public health 
concern. Major etiological factors include 
unemployment, low socioeconomic status, 
long work hours, isolation, lack of socializing 
and substance abuse, etc1. These complaints 
are more frequent among females as 
compared to males which may be due to the 
pressure associated with their social roles in 
everyday life or it may also be linked to the 
hormonal imbalances associated with 
menstruation, childbirth, and menopause1.  
 
Depression, anxiety and stress significantly 
affects the individual’s personal, social and as 
well as professional life. It is evident that 
regardless of age, gender or professional 
seniority, the HP’s are frequently exposed to 
stressful conditions especially in their work 
setting2-4. Modulating the work life, 
depression and stress associated mood 
disorders greatly affect the HP’s 
concentration at work and also compromises 
the quality of healthcare services they 
provide5,6,7.  Based on the systemic review 
conducted in 2015 including 15 countries, the 
estimated prevalence of depressive 
symptoms among the physicians of four 
Asian, seven European and four Middle 
Eastern countries was 28.8%, it was 
suggested that the prevalence ranges in 
between 20.9% to 43.2% and excel each year8.  
 
The incidence rate varies among the different 
occupational categories i.e. nurses are more 
affected by depression, the increasing stress 
is mainly due to the overburdened work 
routine. A study reported high depression 
rate (18%) among nurses as compared to 
other HP’s (9.4%)9. According to a local study 
including physiotherapists employed in 
major cities of Pakistan, 70.1% were suffering 
from depression, 53.17% from anxiety and 
60.05% were in stress10. However, it is 
apparent that depression, anxiety and stress 
are primarily caused by workload while 
other secondary causes are financial status, 
job stress and dissatisfaction etc10. Nurses all 

around the world face it and it is linked to 
their long work hours, frequent night shifts 
and violence at work-place11 and sometimes 
it even leads to intentions to quit job12. It not 
only alters the mental and physical health, 
also reported to increase the substance use, 
abuse and suicide risk among the HP’s7,13. 
 
The aim of the present study was to estimate 
the prevalence of depression, anxiety and 
stress among the HP’s at tertiary care 
hospitals of Karachi.  

 

Methodology 
This cross-sectional multicenter study was 
conducted at three tertiary care hospitals of 
Karachi including JPMC, NICH and NICVD 
from May to July 2019. A sample of 260 was 
calculated using open epi software version 
2.3.1, including six different categories of HPs 
(doctors, nurses, physiotherapists, 
pharmacist, laboratory technicians and 
nursing technicians). The targeted 
population for this study was HP’s involved 
in preventive, curative and rehabilitative 
healthcare services at the study setting. The 
HP’s demographic details including age, 
gender, marital status, education and 
profession etc. were taken after attaining the 
written informed consent.  Depression, 
anxiety and stress was assessed using DASS 
4214. The sum of scores was obtained from the 
14 items in each scale and the scale severity 
was interpreted as per the details shown in 
the table below.  
 

Table 1: Cut-off score for severity ratings of 
DASS 42 severity scale 

Grades Depression  Anxiety Stress 

Normal 0 – 9 0 – 7 0 – 14 

Mild 10 – 13 8 – 9 15 – 18 

Moderate 14 – 20 10 – 14 19 – 25 

Severe 21 – 27 15 – 19 26 – 33 

Extreme 
severe 

28 + 20 + 34 + 

*Depression, Anxiety & Stress subscales of DASS42 

 
 



 

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Ethical approval was obtained from St. James 
institute of nursing and health sciences. The 
collected data was analyzed using SPSS 
Version 23, where frequency and percentages 
were used to present the qualitative variables 
of the study like gender, marital status and 
socioeconomic status, etc. 
 

Result 
During the study period, 260 HP’s from 
diverse professions and specialties were 
included in the study, majority were nurses 
i.e. 58.1% followed 18.1% were doctors and 
9.6% were nursing technicians with female 
predominance 134 vs 126 males. 94.6% had a 
work experience of <15 years.   

 

Table 1: Socio-demographic characteristics of study participants  

Variables Sub-categories (n=260) 

Gender Male 126(48.5) 
Female 134(51.5) 

Age Group  <35 years 224(86.15) 

>35 years 36(13.84) 

Marital status Married  169(65) 

Single/widow/separated 91(35) 

Education Undergraduate  56(21.5) 
Postgraduate  43(16.5) 

Others 161(61.9) 

Socioeconomic status <PKR 50,000 83(31.9) 

PKR 50,000 – 100,000 136(52.3) 

PKR 100,000 – 150,000 31(11.9) 

>PKR 150,000 10(3.8) 

Professional Categories  Nurse 151(58.1) 

Nursing technician 25(9.6) 

Laboratory technician 7(2.7) 

Pharmacist 6(2.3) 

Doctor 47(18.1) 

Physiotherapist 24(9.2) 

Affiliation JPMC 73(28.1) 

NICVD 95(36.5) 

NICH 92(35.4) 

Work Experience <15 years 246(94.6) 

>15 years  14(5.38) 
*JPMC-Jinnah Post-Graduate Medical Centre; NICVD-National Institute of Cardiovascular 
Diseases; NICH-National Institute of Child Health 

The mean DASS scores for the prevalence of depression, anxiety and stress are given in table 

2. Out of the total sample, 51.5% HP’s scored normal on depression subscale while 22.7% fell 

into the mild category followed by moderate 12.7% and 2.3% showed extreme scores. For 

Anxiety subscale, 39.6% HP’s had normal scores and 25.8% had moderate scores for anxiety 

while 8.1% were having extremes severity scores. DASS42 Stress subscale displayed normal 



 

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scores among 58.1% HP’s, 17.3% moderate scores, 16.9% mild scores and 2.7% extreme 

scores. 

Table 2: Prevalence of depression, anxiety and stress in study participants  

Score Severity Ratings Depression  Anxiety Stress 

Normal 134(51.5) 103(39.6) 151(58.1) 

Mild 59(22.7) 37(14.2) 44(16.9) 

Moderate 33(12.7) 67(25.8) 45(17.3) 

Severe 28(10.8) 32(12.3) 13(5) 

Extreme 6(2.3) 21(8.1) 7(2.7) 
* Depression, Anxiety & Stress subscales of DASS42 
*Values are given as n(%) 

 
The association of depression, anxiety and stress with various sociodemographic 
characteristics is given in table 3. No significant relationship observed between the observed 
variables and the prevalence of depression, anxiety and stress. 
 

Table 3: Stratification of sociodemographic factors with depression, anxiety and stress. 
 

Associated Factors Depression 
p-

value 
Anxiety 

p-
value 

Stress p-value 

Gender  
Male 63 

0.630 
76 

0.983 
49 

0.279 
Female 63 81 61 

Age 
Groups  

<35 years 111 
0.707 

136 
0.525 

98 
0.250 

>35 years 15 88 126 

Marital 
status  

Single/widow/separated 46 
0.621 

52 
0.433 

40 
0.693 

Married 80 105 70 

Socioecono
mic status 

<PKR 50,000 41 

0.957 

52 

0.537 

37 

0.809 
PKR 50,000 – 100,000 66 81 58 

PKR 100,000 – 150,000 15 20 12 

>PKR 150,000 4 4 3 

Professiona
l categories  

Nurse 74 

0.436 

95 

0.063 

64 

0.08 

Nursing technician 15 14 6 

Laboratory technician 3 5 2 

Pharmacist 1 0 1 

Doctor 20 23 20 

Physiotherapist 13 20 17 

*Values are given as frequency 

 

Discussion 
The prevalence of depression, anxiety and 

stress was high among the HP’s enrolled in 

the current study i.e. 48.46%, 60.38% and 

41.92% respectively which is consistent with 

the findings of Alkhazrajy et al.15 (70.25%) 

and Liezel16(55%). While in contrast studies 

conducted in Japan, China and Germany 

showed decreased prevalence of depressive 

symptoms among HP’s i.e. 11.3%, 8.8%, 

31.7%, and 17%, respectively17-19. Moreover, a 

local study in Pakistan also showed similar 

results to the mentioned studies i.e. 25.8% 

prevalence only20. The high prevalence of 

depression among the study population may 

be due to the increasing workload, lack of 

working staff, limited number of HP’s and 

low income.  



 

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Stratification of sociodemographic 

characteristics of the study population with 

depression, anxiety and stress showed 

insignificant results i.e. no significant 

association was observed between age and 

depression levels (p=0.707) which is also 

supported by other studies concluding age as 

a nonsignificant contributing factor for 

depressive symptoms in medical 

profession21,22. Moreover, working hours are 

the significant contributing factors for 

depression, anxiety and stress as indicated by 

a number of studies5,21. The physicians who 

were working for more than 60 hours/week 

and in double shifts were more likely to 

experience depressive symptoms as 

compared to counterparts22. A study 

indicated that low income was also a 

common factor among the HP’s with 

depressive symptoms23 which is 

contradictory to other studies indicating no 

significant relationship between the two 

variables. Also supported by our results I 

indicating contradictory results (p=0.957) to 

the study conducted by El-Hamrawya23.  

The current study indicated a higher rate of 

depression among males as compared to 

females i.e. 63/126 vs 63/134. While globally 

it is an evident fact that the prevalence of 

depressive symptoms is higher among 

females irrespective of professions, also 

showed by several studies where females 

were more depressed than males24-26. 

Furthermore, the marital status also plays a 

significant role in the prevalence of 

depression, anxiety and stress. It was 

reported by a study that married doctors are 

more likely to develop depression as 

compared to unmarried23. No significant 

associations observed in the current study 

which is also supported by Gu et al.27, 

Alkhazrajy et al.15, Becker et al.21 and 

Fahrenkopf et al.5, concluding that no 

significant association exist between gender, 

marital status and prevalence of depressive 

symptoms.  

There are several studies conducted both at 

national and international level determining 

the prevalence of depression, anxiety and 

stress among single category of HP’s but our 

study is unique in the way that it brought 

various categories of HP’s under one 

umbrella, like nurses, doctors, laboratory 

technicians, physiotherapist and pharmacist 

were all included in this study. Moreover, 

DASS 42 is valid tool for depression analysis 

and three major hospitals of Karachi were 

included for the study but sample size is very 

limited due to shortage of time and answers 

of some behaviour questions might be 

doubtful because participants might have 

lied about it. Therefore, our results do not 

provide a generalized view. It is 

recommended that hospitals should be aware 

of the increasing prevalence of depression, 

anxiety and stress among HP’s, and 

assessments should be carried out 

periodically. Moreover, firm policies and 

campaigns must be designed and 

implemented to eradicate this health issue so 

that continuous and balanced services could 

be provided to the patients. It is also 

suggested that further studies with more 

participants from both government and 

private sectors should be conducted so the 

results can be properly estimated at whole 

community level. 

Conclusion  
The HP’s enrolled in the study were mostly 

affected by moderate to severe level of 

depression, anxiety and stress. Periodic, 

monthly or bimonthly assessment of these 

measures are recommended to control this 

health concern among the HP’s. As their 

physical and mental health status plays a 

very significant role in their practicing 

environment and also affects the quality of 

services they are providing. Programs and 

campaigns must be driven in order to 

increase the knowledge of these concerns 

among the HP’s and in order to improve the 

mental health of the employees the 



 

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healthcare sectors must take effective 

measures focusing on better health and 

healthy working environment. 

Acknowledgement  
St. James Institute of Nursing & Health 

Science. 

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