i

MUHIMBILI UNIVERSITY OF HEALTH AND ALLIED SCIENCES

DEPARTMENT OF PSYCHIATRY AND MENTAL HEALTH

MENTAL DISTRESS AND ASSOCIATED JOB RELATED FACTORS AMONG

NURSES AT MUHIMBILI NATIONAL HOSPITAL IN DAR ES SALAAM

Candidate

Peter Gamba (MD)

REG NO: HD/MUH/T.284/2020

Supervisor: Frank Masao (MD, MMED)

Co Supervisor: Ms Tasiana Njau

A Proposal Submitted in (Partial) Fulfillment of the requirement for the degree award of Master
of Medicine (Psychiatry and Mental Health) of the Muhimbili University of Health and Allied
Sciences
 ii

February, 2023

TABLE OF CONTENTS

LIST OF ABBREVIATIONS......................................................................................................iv

DEFINITION OF TERMS...........................................................................................................v

ABSTRACT..................................................................................................................................vi

1. INTRODUCTION..................................................................................................................1

1.1. Background............................................................................................................................1
1.2. Problem statement.................................................................................................................2
1.3. The conceptual framework....................................................................................................2
1.4. Rationale and justification of the study.................................................................................4
1.5. Research questions.................................................................................................................4
1.6. Broad objective.....................................................................................................................4
1.7. Specific objectives..................................................................................................................4
1.8. Research hypothesis.................................................................................................................5
1.9. Literature review........................................................................................................................6
2. METHODOLOGY...............................................................................................................13

2.1. Study design.........................................................................................................................13

2.2. Study area and setting.........................................................................................................13
2.3 Study duration.....................................................................................................................13
2.4 Study population.................................................................................................................13
2.5 Inclusion and exclusion criteria...........................................................................................14
2.6 Sample size calculations.......................................................................................................14
2.7 Sampling techniques............................................................................................................15
2.8 Data collection procedure....................................................................................................15
2.9 Variables..............................................................................................................................16
2.10 Tools and measurements.....................................................................................................16
2.11 Data analysis plan....................................................................................................................17
2.12 Ethical issues........................................................................................................................17
 iii

2.13 Study limitations and mitigations........................................................................................18

2.14 Work plan................................................................................................................................18
2.15 Proposal budget.......................................................................................................................20
1.16 Justification of budget.........................................................................................................22
1.17 Dissemination of the findings...............................................................................................22

3. REFERENCES........................................................................................................................23

4. APPENDICES.................................................................................................................................28
4.1 Consent form – English.............................................................................................................28
4.2: Fomu ya ridhaa kwa mgonjwa.................................................................................................32
4.3 Screening tool- English version.................................................................................................35
4.4 screening tool- swahili version...................................................................................................45
4.5 Questionnaire – English version...............................................................................................55
4.6 Questionnaire –Swahili version................................................................................................58
4.7 Data extraction and file screening sheet....................................................................................61
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LIST OF ABBREVIATIONS

AOR Adjusted Odd Ratio

CBT Cognitive Behavioral Therapy

DSM 5-TR Diagnostic and Statistical Manual for Mental Disorders Fifth Edition Text
Review

MNH Muhimbili National Hospital

MUHAS Muhimbili University of Health and Allied Sciences

OR Odds Ratio

WHO World Health Organization

WHODAS World Health Organization Disability Assessment Scale

BAC Blood alcohol Concentrations
DALYS Disability Adjusted Life Years
AUDIT Alcohol Use Disorder Identification
LIC
Low-income Countries
LMICs
Lower- and Middle-income Countries
PTSD
Post-traumatic Stress Disorder

AUD Alcohol use disorders

SD Standard Deviation
SPSS Statistical Package for Social Science
PD
Psychological Distress
MD
Mental Distress
 v

DEFINITION OF TERMS

Mental distress is a combination of abnormal thoughts, emotions and behavior which

significantly affects normal life style of individuals in areas of self-efficacy, self autonomy,
competence and the ability to realize one’s own intellectual and emotional potential

A Job-related mental distress is a psychological injury or illness caused by one or more

substantial sources of stress at a person’s job or by one or
more job-related traumatic events.

Psychosocial job characteristics refers to ‘factors involved with psychosocial processes

linked to the social environment of work that may be
important in the causation of illness’ these are common
exposures to which all workers may potentially be exposed.

substance use is defined as the inappropriate consumption of medicines, drugs, or other

materials including prescription drugs, over-the-counter
drugs, street drugs, alcohol, and tobacco.
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ABSTRACT

Background: Mental distress is combination of abnormal thoughts, emotions and behavior

which significantly affects normal life style of individuals in areas of self-efficacy, self-
autonomy, competence and the ability to realize one’s own intellectual and emotional potential.
The incidence and prevalence of mental disorders in the working population is getting increased
in the last decades. Mental distress affects 15 up to 25 percent of working population globally
and contributes greater impact negatively on global economy by affecting human resource
through increasing absenteeism from work, sick leave, compensations and by other different
reasons

Mental distress is the most common problem among health professionals working in health care
facilities due to psychosocial challenges, high work related stressors and other socio-economic
factors. Work and work organization conditions affect psychological well-being of employees as
a result of excessive working hours, time constraints for their families, conflict with staffs, role
ambiguity and job insecurity. Poor chances for advancement (promotion), verbal or physical
harassment from superiors,

Health professionals with mental distress could not deliver there required care and unable to
play their crucial role to their health care facility and to their community especially in the time of
advanced health care technologies, complex care processes, complex patient needs, and complex
organizational systems.

Objectives: To assess the prevalence of Mental Distress and associated Job related factors among
Nurses at MNH in Dar es salaam.
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Materials and Methods: This will be a hospital based cross-sectional analytical study with

quantitative approach involving staff aged 18 years and older at Muhimbili National Hospital in
Dar es Salaam. A semi-structured questionnaire will be used to collect socio-demographic
information and clinical characteristics of the study population. Questions of the General Health
Questionnaire 12 (GHQ 12) will be used and those who will score more or equal to six will
indicate positive mental distress, for psychosocial job related characteristics a job content
questionnaire (JCQ) that has been dichotomous will be used and for substance use Cut down,
Annoyed, Guilty and Eye opener (CAGE) will be used with a score more than two indicating
positive use.

Data will be analyzed using statistical package for social sciences (SPSS) version 23. Descriptive
statistics will be used to analyze social-demographic information and clinical characteristics.
Bivariate and Multivariate logistic regression analyses will be done to find the association
between the Mental Distress and selected associated Job related factors. All variables associated
with Mental Distress with a p-value of less than 0.2 in bivariate analysis will be further analyzed
using multivariate logistic regression analysis. Beta Coefficients and Pearson (p) values of less
than 0.05 will be used as statistical inference to describe the significance association between
Mental Distress and the associated Job related factors.

Ethical clearance will be obtained from MUHAS Senate Research and Publications Committee
and permission to conduct the study will be sought from MNH authority. Informed consent will
be sought from eligible participants before data collection.

Budget and timeline: A total of Tsh 1,522,800/= has being budgeted for this study and
sponsored by the ministry of health, community development, gender, elderly and children
(MOHCDGEC).
 1

CHAPTER ONE

1. INTRODUCTION

1.1. Background

Mental distress is combination of abnormal thoughts, emotions and behavior which significantly
affects normal life style of individual areas of self-efficacy, self-autonomy, competence and the
ability to realize one’s own intellectual and emotional potential [1,2]. Different studies proved
that the incidence and prevalence of mental disorders in the working population is getting
increased in the last decades. Mental distress affects 15 up to 25 percent of working population
globally [3,4].

Mental distress is contributing greater impact negatively on global economy by affecting human
resource through increasing absenteeism from work, sick leave, compensations and by other
different reasons[5,6]. Mental distress is the most common problem among nurses working in
health care facilities due to psychosocial challenges, high work related stressors and other socio-
economic factors [6,7]. Work and work organization conditions affect psychological well-being
of employees as a result of excessive working hours, time constraints for their families, conflict
with staffs, role ambiguity and job insecurity. Poor chances for advancement (promotion), verbal
or physical harassment from superiors, health and safety risks were also identified sources of
mental distress at work place [5,9,10].

Also Working environment and co-worker communication, administrative issues (office politics
and competition), family relationship and level of income were found to be highly associated
with the occurrence of mental distress among nurses especially when employees fail to purchase
adequate food, clothing and services in their salary which affects their self-esteem as well as the
sense of control over one’s life [3,11].

Many of lost work days each year are due to absenteeism, sick leave and unreasonable leave
from work are attributed to mental distress and most of the nurses employees consider quitting
their jobs because of complaining about emotional instability and unable to solve stressful
conditions of their work [12-14].
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1.2. Problem statement

Globally, Mental distress affects 15 up to 25 percent of working population and more various
studies done in Asia and SSA did found that, the prevalence of Mental distress among nursing
staffs ranged between 34.7% to 79% respectively. [3,4]

The prevalence of mental distress is ranged between 5% and 27% in the general population (PD
(1) 10-14), while the study conducted in Nigeria revealed that it raises up to 44.1%among nurses
(PD (1) 15). Therefore, the high prevalence of mental distress among nurses due to poor
interaction among staff and workload also contributes to high turnover and decrement of job
satisfaction which become a global issue (PD (1)16).

Mental distress due to stressful working conditions is the second most compensated case to
employees following musculoskeletal disorders in Australia [15]. A study done in Nepal among
a tertiary care staffs working at different departments found that, 34.7% prevalence of mental
distress among nursing staffs [16].

Another study conducted in University of Limpopo, South Africa on 109 nurses’ found that, the
majority of respondents were unhappy with Payment; 79% of them said they were not paid
enough for what they did and for what they deserved; and 60% of them felt that the organization
should increase their payment considering to their demanding work [17].

By knowing this study it will help to guide nurses and policy-makers in planning ways to
counteract its effects and optimize nurse well-being and patient outcomes.

Limited studies have being conducted in Tanzania to assess the prevalence of Mental Distress
and associated Job related factors among Nurses. Therefore this study will determine the
prevalence of Mental Distress and associated Job related factors among Nurses at MNH in Dar
es salaam.
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1.3. The conceptual framework

The Biopsychosocial model has been used and studied for many years by various scientists and
clinicians. It was first proposed in United States by George Engel (Engel, 1977), According to
Engel there is connection of societal and molecular constructs through biological, psychological
as well as social events which are found to have a mutual interconnected and reciprocal influence
on one another on disease and its treatment.

The biopsychosocial theory considers that biological, psychological and social factors play a role
in the understanding of physical and psychological well-being, disease and management of the
disease (Borell-Carrió et al., 2004). These biopsychosocial factors show their influences at
different levels, including predisposing, precipitating, and maintaining or protecting against
mental disorder occurrence, as summarized in Figure 1.

The adaption of the model (Engel, 1977) will be used in the understanding the interaction of
biological factors like age, sex, family history of mental illness, and alcohol use while
psychosocial job related factors like job demand, job control, job satisfaction, social support and
staff relationship on how they are interlinked in coining mental distress among Nurses at MNH
in Dar es salaam.
Mental Distress

Psychosocial Factors:
Biological Factors:
Job demand, job control, job
Age, Sex, family history of Mental
satisfaction social support and
illness and alcohol use
staff relationship

Figure 1: Adapted Biopsychosocial model illustrating factors associated with mental distress
among nurses.
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1.4. Rationale and justification of the study

In Tanzania, the lack of reliable data on Mental Distress often hinders officials from planning for
preventive actions. The burden of Mental Distress remains challenging among health care
workers.

Since health workers contribute a major role in the provision of care for the patients in every
health institution twenty-four hours a day and seven days a week, assessing for the prevalence of
Mental Distress and its associated Job related factors in a public hospital of MNH Dar es salaam
will be helpful for policymakers to provide the timely intervention.

This study will also help to inform the hospital management about the possible ways to modify
the obtained prevalence and associated Job related factors especially modifiable once and hence
reduced Mental Distress among staff at MNH.

The study is also for partial fulfillment of the requirements for the master of medicine in
psychiatry and mental health.
 5

1.5. Research questions

1. What is the prevalence of Mental Distress among nurses at MNH in Dar es Salaam?
2. What are the associated Job related factors that are associated with Mental Distress
among nurses at MNH in Dar es Salaam?

1.6. Broad objective

To assess the prevalence of Mental Distress and associated Job related factors among Nurses at

MNH in Dar es salaam

1.7. Specific objectives

1. To assess the prevalence of Mental Distress among Nurses at MNH in Dar es salaam
2. To assess the association between Psychosocial Job related characteristics and Mental
Distress among Nurses at MNH in Dar es salaam.
3. To assess the association between Substance use and Mental Distress among
Nurses at MNH in Dar es salaam.

1.8. Research hypothesis

Null hypothesis

Biological factors (Age, Sex, family history of Mental illness and alcohol use), Psychosocial
factors (Job demand, Job control, Job satisfaction Social support and Staff relationship) has no
effects on the Mental Distress among nurses at MNH in Dar es salaam.

Alternative hypothesis

Biological factors (Age, Sex, family history of Mental illness and alcohol use), Psychosocial
factors (Job demand, Job control, Job satisfaction Social support and Staff relationship) has
effects on Mental Distress among nurses at MNH in Dar es salaam.
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1.9. Literature review

1.9.1 Prevalence of Mental Distress among Nurses

The burden of mental health problems is increasing globally. According to the World Health
Organization (WHO), mental health problems amount to nearly one-third of disability in the
world (1, 2). The lifetime prevalence of mental or behavioral disorders in both developed and
developing countries has been estimated as 25% (3,5). According to a WHO survey in 14
countries during the period 2001 and 2003, the prevalence of mental disorders among nurses was
highest in USA (26.4%) when compared to other countries that varied between 9.1 and 16.9%
(MD6).

In 2021/22, an estimated 1.8 million workers in Great Britain were suffering from an illness
which they believed was caused or made worse by work (either new or longstanding), equivalent
to a rate of 5,390 per 100,000 workers (5.4%) (MD5).

Other Several epidemiological data have confirmed that the incidence of work-related mental
distress symptoms varies from 47% in china to 64.6% India.

In Africa the prevalence of Mental Distress is ranged between 5% and 27% in the general
population (10-14), while the study conducted in Ethiopia and Nigeria revealed that it raises up
to 29.9% among nurses (15).(PD1) to 44.1%(PD5)

The majority of studies have been conducted in well-resourced settings in high-income countries.
However, considering that the largest share of the global burden of disease is found in low- and
middle-income countries such as Tanzania and other SSA, there is limited data concerning
Mental Distress among health care professionals especially nurses working in such areas where
health care systems remain underdeveloped and the impact of Mental Distress on the health care
system is un-quantified. (MD7).

This study seeks to close this informational gap by attempting to synthesize the best available
evidence on the prevalence of Mental Distress among nurses in Tanzania. This evidence will
 7

help guide nurses, researchers, and policy-makers in devising ways to counteract its effects and
optimize nurse well-being and patient outcomes

1.9.2. Job- related Factors associated with Mental Distress among Nurses

Social Demographic characteristics and Mental Distress among Nurses

Age, sex, education level, marital status and family number are among the social demographic
factors which have been associated with likelihood of Mental Distress among nurses. Prevalence
of mental distress among divorced and widowed nurses was found to be high with a prevalence
of 41.7% and 39.1% respectively, and among nurses participants who had no child were showed
slightly higher prevalence of mental distress (32.7%, when compared with those who had at
least one child (26.9%)(MD1)

In other study the done the majority (55.2%) of the nurses participants were males with the

mean age was 31.00 years (SD = 8.219; range 23–57 years). also most of the respondents were
married (53%). A high proportion of the respondents had a BSc degree (82.5%), above degree
(11.8%) and few (5.8%) of the participants had a diploma as their highest level of qualification.
(PD5)

And Most participants (46.3%) had a monthly salary of less than 4466 Ethiopian Birr (ETB) and
(20.4%) reported their monthly salary was > 6176 ETB. A total of (367, 88%) participants were
non- smokers (PD1)

Psychosocial Job related characteristics

With work demand variables such as Physical/verbal abuse, Support regarding Work, Night
shift work, job demand and job satisfaction, Mental distress was nearly three times higher among
nurses participants encountered verbal or physical abuse (42.7%) compared with their
counterparts (21.1%,) and nurse participants with history of physical illness in the last one month
showed 2.36 times higher prevalence of mental distress compared to their counterparts. (MD1)

The odds of having Mental distress are almost 10 times more likely in those participants with the
job title of a staff nurse as compared with a head nurse [AOR= 10.13, 95% CI (1.85, 55.41)].
Participants whose working experience are 6-10 years are almost 5 times more likely to have
 8

Mental distress than those participants with experience of 1-3 years [AOR= 4.98, 95% CI (1.59,
15.568)].

Nurses with good interaction with other staff members are 30.5% times less likely to be Mentally
distressed as compared with their counterparts [AOR= .305, 95% CI (.117, .796)]. Participants
with fatigue are 2.5 times more likely to have mental distress as compared with their counterparts
[AOR= 2.54, 95% CI (1.072, 6.02)]. Those participants with intermediate social support are
18.9% times less likely to have Mental distress than those with poor social support [AOR= .189,
95% CI (.075, .474)]. Besides, participants with perfectionism are almost six times more likely to
develop Mental distress than their counterparts [AOR= 5.697, 95% CI (1.449, 22.39)]. The odds
of having Mental distress were almost 4 times more likely in those participants with a minor
problem with sleep as compared with those participants with normal sleep [AOR= 3.82, 95% CI
(1.52, 9.579)](PD1)

Generally variables including sex, educational status, monthly salary, work experience, family
size, professional status, habits of cigarette smoking, khat chewing, high job demand, low job
control, poor staff relationships, job dissatisfaction, and low perceived organizational support
were explored to considerably influence work-related mental distress. (PD5) and After
controlling for confounders in a multivariable logistic regression analysis, sex, high job demand,
and low job control remained to significantly influence the experience of selfreported work-
related mental Distress.

Accordingly, the probability of having work-related Mental Distress was 2.07 times higher
among nurse female study participants than males [AOR: 2.07; 95% CI (1.29, 3.32)]. Moreover,
the chance of suffering from work-related mental distress was 1.53 times higher among nurse
participants who encountered high job demand than those who reported low job demand
[(AOR:1.53; 95% CI (1.10, 2.57)]. As well, the probable occurrence of work-related mental
distress was increased by two and half among respondents who did not able to control their jobs
than among those who have capacity to control their job [AOR: 2.54; 95% CI (1.60, 4.04)](PD5)
 9

Substance use

Substance related factors Among the nurse study participants 14.4% of them were found to have
alcohol use disorder (CAGE≥2). Participants with alcohol use disorder were identified to have
2.63 times higher prevalence of mental distress than their counterparts (50%) and Current khat
users and current tobacco smokers were similarly developed 2.22 times (44.0%) and 3.54 times
(57.6%) higher prevalence of mental distress than non-users in bivariate analysis.(MD1)
 10

CHAPTER TWO

2. METHODOLOGY

2.1. Study design

The study will be a hospital based analytical cross-sectional study which will employ the
quantitative approach.

2.2. Study area and setting

The study will be conducted at Ilala District, Dar es Salaam region Tanzania. Dar es Salaam is a
major commercial city in Tanzania with high populations of 7,405,000 people by census report
of 2022 (POP STAT MD9). The study will be conducted among Nurses working at Muhimbili
National Hospital (MNH). MNH is a national referral hospital comprising of two campus
Upanga and Mloganzila with the number of nurses being 1009 and 300 respectively and they do
receive all kinds of patients including those with mental disorders from within the city and from
nearby regions.

2.3 Study duration

The study will be conducted from October 2022 to August 2024, where, proposal development
will be done through October 2022 to March, 2023 and data collection and data cleaning will be
done during the period of August 2023 to January 2024. Data analysis and report writing and
submission will be done from February to august 2024.

2.4 Study population

The study population will be nurses staffs aged 18years and above working at MNH, Dar es
salaam Tanzania during the period of study and meeting other inclusion criteria.
 11

2.5 Inclusion and exclusion criteria

Inclusion

1. Nurses staffs working at MNH aged 18years who had worked for at least 6 months in the
study area prior to the study

2. Nurses staffs who were present and working during the study period

3. Being a Nurse and working at MNH

Exclusion

1. Nurses who were on sick, annual, maternity, and family leaves.

2. Nurses staff who will not consent to participate in the study

2.6 Sample size calculations

The sample size is calculated by using Slovin's Formula for finite population

n = 1+ Ne2N

where n = Number of samples, N = Total population and e = Error tolerance Data: n = ?

N = 1309 and e = 0.05

N = 1309/1 + 1309 x 0.05 x 0.05 = 306

After adjusting for 10% NR = 360

2.7 Sampling techniques

The stratified sampling method followed by simple random sampling technique to recruit eligible
samples will be used. List of Nurses and its categories will be obtained from Human resource
 12

(HR) departments and from Director of nursing services of MNH. The selected nurses will be
approached and requested to participate willingly in the study and will have to sign a written
consent. For the patient who will not consent to be involved in the study and those who will not
meet inclusion criteria, they will be thanked and channeled appropriately into their work stations.
In order to meet the target number of participants on time, about eight patients will be
approached per day in every work station for a total of 8 weeks. Two research assistants with
medical background will be recruited and trained in the process of data collection. It will be
clearly stated that no payment/compensation for time or transport but extra-care will be observed
not to compromise with the any nursing work duties and station.

2.8 Data collection procedure

All nurses who consented for participation will be screened for Mental Distress using Questions
of the General Health Questionnaire 12 (GHQ 12). Also Primary data using Questionnaire
Assessing Basic Demographic Data (SDIQ), Job Content Questionnaire (JCQ) for assessing Job
related characteristics and Cut down, Annoyed, Guilty and Eye opener (CAGE) for assessing
substance use such as alcohol.

Appreciations in terms of words of thanks for those who will accept to participate will be
offered while the word of apology will be extended to those who accepted to participate but not
eligible. The self administered questionnaire will be distributed every morning to specific
selected work stations and they will be collected everyday at the end of the working hours, the
questionnaire will have no names of the study participants or any information indicating the
person involved.

2.9 Variables

Independent variables

Biological variables include: Age, sex and substance use

 13

Psychosocial variables include: Education level, Marital status, Monthly Salary, rank, work
experience, family number, Job demand, Job control, Job satisfaction, Perceived social support
and staff relation

Dependent variables: Mental Distress

2.10 Tools and measurements

Four different tools will be used for data collection as described below

i. Semi-structured questionnaire, this will be used to collect the social demographic

information on patients (SDIQ) age, gender, marital status, educational level, monthly
salary, rank, work experience, family number and cigarette smoking.

ii Questions of the General Health Questionnaire 12 (GHQ 12) will be used and those who
will score more or equal to six will indicate positive mental distress.

iii Psychosocial job related characteristics a Job content questionnaire (JCQ) that has been
dichotomous will be used.

iv Substance use will use Cut down, Annoyed, Guilty and Eye opener (CAGE) will be used
with a score more than two indicating positive use.

2.11 Data analysis plan

Data entry and analysis will be done by the PI, data cleaning will be done to ensure quality and
consistent. The collected data will be entered into the computer and analyzed by utilizing a
statistical package for social science (SPSS for windows version 23). After data cleaning,
 14

descriptive analysis of the sample on social demographic and Job related characteristics data will
be done. Uni-variate analysis using descriptive statistics will be presented in tables using means,
frequencies, and ranges for each variable to be studied.

Bivariate logistic regression will be performed to determine the associations between the
predictors and the outcome of interest (Mental Distress). Multivariate logistic regression will be
used for controlling confounders for factors with p-value <0.2. The variables with a p-value <
0.05 will be considered to be statistically significant.

2.12 Ethical issues

Research clearance will be requested from MUHAS Senate Research and Publications
Committee. The study sample will involve nurses working at MNH, which is one of the
vulnerable populations. The informed consent will be sought from each participant who is stable
to make a decision. All participants will be informed about the study verbally and will be
provided with information on potential risks and benefits of participating. Then nurses will be
asked to participate in the study voluntarily after reading, full understanding and then signing
written consent forms. It will be clearly communicated that refusal to participate in the study will
not bear any consequences to the recruits, and that they are free to agree or refuse. Clients will
also be assured of confidentiality and the questionnaire will not have any client’s name, only the
questionnaire number will be used to identify participants, therefore assuring that information
provided will be confidential. To avoid vulnerability and mitigating, the recruiting officer will
not be a nurse on duty for the day and will be not directly involved in the managements study
participants for that day..

2.13 Study limitations and mitigations

The study is prone to information bias, as tools will clinician/research assistant administered.

The study will not be able to explain causal relationship as it is cross-sectional study.
 15

2.14 Work plan

Activity Time Frame (2022-2024)

Oct Nov Dec Jan Feb Mac Apr May June July Aug- Jan Feb- A
Dec July
2022 2022 2022 2023 2023 2023 2023 2023 2023 2023 2024 2
2023 2024

Selectio
n of
research
topic

Proposa
l
develop
ment
 16

Proposa
l
Submiss
ion

Request
for
Ethical
Clearan
ce

Training
research
attendan
ts and
data
collectio
n
 17

Data
entry,
Data
analysis,
report
writing
and
submiss
ion.

2.15 Proposal budget

Preparatory phase

No Particulars secretarial Quantity Unit Cost Amount (TZS) Total (TZS)

Services (TZS)
 18

1. Ream A4 2 10,000 20,000 20,000

Photocopy 422 400 168,800 168,800

Pens 15 200 3000 3000

Note book 4 500 2000 2000

Subtotal 193,800

2. Field and personnel expenses

Allowance 2 10,000 20,000 20,000

Drinks and bites 3 people 5000 15000 15000

Marker pen 4 1,000 4000 4000

Research assistants 2 people Half per diem 30,000 600,000

Transport costs 2 people 35000 70,000 70,000

Subtotal 709,000

3 Data analysis and management

 19

Statistics Analyst 1 300,000 300,000 300,000

Subtotal 300,000

4 Report compilation, publication and dissemination

Dissertation printing and 100 200@4x2 160,000 160,000

Correction

Dissertation binding 4 40,000 160,000 160,000

Subtotal 320,000

Grand total 1,522,800

I.16 Justification of budget

There is a need to recruit research assistants considering the number of study participants and
completing data collection on time. This will enable a successful analysis and compilation of
results in time. The purchase of stationeries for data collection, photocopying and binding of the
proposal and dissertations are required for a successful completion of the study. In addition, there
is need of statistics expert for expert opinions on data cleaning, data management and reporting
of findings. The total budget is adjusted to one million and five hundred twenty-two thousand
and eight hundred Tanzanian shillings.
 20

I.17 Dissemination of the findings

The results obtained will be submitted to the Department of Psychiatry and Mental health
Muhimbili University of Health and Allied Sciences (MUHAS); as part of the fulfillment of
Masters in Psychiatry and a manuscript for publication.

CHAPTER THREE

3. REFERENCES

1. World health organization (2001) Mental Health Policy and Service Provision Geneva, Switzerland 1-
169.

2. World health organization (2013) Investing in mental health. Geneva, Switzerland, WHO report.

3. Orpana HM, Lemyre L, and Gravel R (2009) The role of the social environment. Spastics Canada Health
Reports 20: 1-7.

4. British Occupational Health Research Foundation (2005) Work place interventions for people with
common mental health problems, Evidence review and recommendations. BOHRF report.
 21

5. Medibank Private and Workplace Health (2013) The Cost of Workplace Stress in Australia.

6. World Health Organization and International Labour Organization (2002) Mental Health and Work-
impact, issues and good practices.

7. World Federation for Mental Health (2013) Mental Health and Chronic Physical Illnesses.

8. Boldor N, Bar-Dayan Y, Rosenbloom T, Shemer J, Bar-Dayan Y (2012) Optimism of health care workers
during a disaster: a review of the literature. Emerg Health Threats J 5.

9. Marchand A, Drapeau A, Beaulieu-Pracvost D (2012) Psychological distress in Canada: the role of

employment and reasons of non-employment. Int J Soc Psychiatry 58: 596-604.

10. Moustaka E, Antinidis TC (2010) Sources and effects of Work-related stress in nursing, Health Science
Journal.

11. Goulia P, Mantas C, Dimitroula D (2010) General hospital staff worries, perceived suficiency of
information and associated psychological distress during the A/H1N1 inluenza pandemic. BMC Infectious
Diseases 10: 322.

12. Blewett V, Shaw A, Anthony D (2006) Job Stress, Causes, Impacts and Interventions in the Health and
Community Services Sector.

13. Rebecca M (2014) Stress in work place a costly epidemic. Fairleigh Dickinson University News letter
FDU web page.

14. Authors Hughes RG Nurses at the Sharp End of Patient Care. Nurses at the Sharp End of Patient Care.

15. Australian government safety and compensation council (2013) Work-Related Mental disorders in
Australia.

16. Shakya DR, Lama S, Shyangwa PM (2012) Psychological problems among nursing staff in a hospital.
JNMA J Nepal Med Assoc 52: 102-110.

17. Pietersen C (2005) Job satisfaction of Hospital Nursing Staff. SA Journal of Human Resource
Management 3: 19-25.

18. World health organization division of mental health (1994) User’s Guideline to the Self Reporting
Questionnaire. World Health Organization Geneva.

19. Kortmann F (1988) Problems in practising psychiatry in Ethiopia. Ethiop Med J 26: 77-84.

20. Chipimo PJ, Fylkesnes K (2010) Comparative validity of screening instruments for mental distress in
zambia. Clin Pract Epidemiol Ment Health 6: 4-15.

21. Campos JA, Carlotto MS, and Maroco J (2013) Copenhagen Burnout Inventory Validation. Relexao
Critica, 26: 87-97.
 22

22. Smit AM. Psychometric properties of the Copenhagens Burnout Inventory in South African context.
University of Pretoria, September, 2011.

23. Damena T, Mossie A, Tesfaye M (2011) Khat chewing and mental distress: a community based study,
in jimma city, southwestern ethiopia. Ethiop J Health Sci 21: 37-45.

24. Dhalla S, Kopec JA (2007) The CAGE questionnaire for alcohol misuse: a review of reliability and
validity studies. Clin Invest Med 30: 33-41.

25. Audu MD, Tesfaye M, Gurmu S, et al. Lifetime prevalence of substance abuse and mental distress
among homicide offenders.

26. Ardekani ZZ, Kakooei H, Ayattollahi SM, Choobineh A, Seraji GN (2008) Prevalence of mental
disorders among shift work hospital nurses in Shiraz, Iran. Pak J Biol Sci 11: 1605-1609.

27. Gelaye B, Lemma S, Deyassa N, Bahretibeb Y, Tesfaye M, et al. (2012) Prevalence and correlates of
mental distress among working adults in ethiopia. Clin Pract Epidemiol Ment Health 8: 126-133.

28. Weinberg A, Creed F (2000) Stress and psychiatric disorder in healthcare professionals and hospital
staff. Lancet 355: 533-537.

29. Holt J, Del Mar C (2005) Psychological distress among GPs--who is at risk and how best to reach
them? Aust Fam Physician 34: 599-602.

30. Assuncao AA, Machado CJ, Prais HAC, et al. (2013) Working conditions and common mental
disorders in physicians in Brazil. Occupational Medicine 63: 234-237.

31. Rodwell J, Demir D (2013) Psychological consequences of bullying hospital and aged care nurses.

32. Schmidt SG, Dichter MN, Palm R, Hasselhorn HM (2012) Distress experienced by nurses in response
to the challenging behaviour of residents - evidence from German nursing homes. J Clin Nurs 21: 3134-
3142.

33. Lopes Cardozo B, Gotway Crawford C, Eriksson C, Zhu J, Sabin M, et al. (2012) Psychological distress,
depression, anxiety, and burnout among international humanitarian aid workers: a longitudinal study.
PLoS One 7: e44948.

34. Girma E, Tesfaye M, Froeschl G, Möller-Leimkühler AM, Müller N, et al. (2013) Public stigma against
people with mental illness in the Gilgel Gibe Field Research Center (GGFRC) in Southwest Ethiopia. PLoS
One 8: e82116.

35. Yiengprugsawan V, Harley D, Seubsman SA, Sleigh AC (2012) Physical and mental health among
caregivers: indings from a cross-sectional study of Open University students in Thailand. BMC Public
Health 12: 1111.
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36. Soboka M, Tesfaye M, Feyissa GT, Hanlon C (2014) Alcohol use disorders and associated factors
among people living with HIV who are attending services in south west Ethiopia. BMC Res Notes 7: 828.

37. Horwitz AV. Selecting outcomes for the sociology of mental health: Issues of measurement and
dimensionality. Journal of health and social behavior. 2002;43(2).

38. Association AP. Diagnostic and statistical manual of mental disorders (DSM-5®): American Psychiatric
Pub; 2013.

39. Horwitz AV. Distinguishing distress from disorder as psychological outcomes of stressful social
arrangements. Health:. 2007;11(3):273-89.

40. Ridner SH. Psychological distress: concept analysis. Journal of advanced nursing.2004;45(5):536-45.

41. Dollard MF, LaMontagne AD, Caulfield N, Blewett V, Shaw A. Job stress in the Australian and
international health and community services sector: A review of the literature. International Journal of
Stress Management. 2007;14(4):417.

42. Zhu Z, Xu S, Wang H, Liu Z, Wu J, Li G, et al. COVID-19 in Wuhan: immediate

psychological impact on 5062 health workers. MedRxiv. 2020.

43. Shasha J, Shi, Kong, Qian and Chu. Impact of COVID-19 on psychology of nurses working in the
emergency and fever outpatient:A crosssectional survey. BMC 2020.

44. Health, Executive S. Tackling Work-related Stress: A Managers Guide to Improving and

Maintaining Employee Health and Wellbeing. HS (g) 218: HSE Books; 2001.

CHAPTER FOUR

1. APPENDICES

4.1 Consent form – English

MUHIMBILI UNIVERSITY OF HEALTH AND ALLIED SCIENCES

SCHOOL OF MEDICINE

DEPARTMENT OF PSYCHIATRY AND MENTAL HEALTH

 24

STUDY TITLE: Prevalence of Mental Distress and associated Job related factors among Nurses
at MNH in Dar es salaam

Introduction

My name is Dr. Peter Gamba, a resident at Muhimbili University of Health and Allied Sciences
(MUHAS) in Dar- es- Salaam. I am conducting a study on the Prevalence of Mental Distress and
associated Job related factors among Nurses at MNH in Dar es salaam

You are invited to participate in this study, kindly read this form and understand the content
before agreeing to participate. Any queries you may have or words that you don’t understand
shall be answered. If you have questions, please ask me.

Purpose of the research

The purpose of this research is to determine the prevalence of Mental Distress and associated Job
related factors among Nurses at MNH in Dar es salaam.

What does participation involve?

This research will involve a self administered questionnaire

You sign this consent form and answer the questions in the questionnaire as well as you can.

We are inviting all nurses that are aged 18years and above working at MNH.

Participant information
 25

Your participation in this research is entirely voluntary. Whether you choose to participate or
not, nothing will change. You may change your mind later and stop participating even if you
agreed earlier.

Confidentiality

Information about you that will be collected during the research will be kept confidential and no-
one but the researchers will be able to see it. We will not be sharing the identity of those
participating in the research.

Risks

By participating in this research, you will not be subjected to any risk.

Work from all research participants stations shall continue with no interruption from the
principal investigator or assistants.

Benefits

The benefits will be participation in a study that will lead to early identification of features
suggestive of Mental Distress and further expert evaluation and management will follow there
after.

If you have any questions related to this study, or your health you can contact the principal
researcher Peter Gamba 0766-159-460 or my supervisor Dr. Frank Masao 0754- 288-673. You
can also contact the chairperson of the Research Senate and Publication committee, Dr.Bruno
Sunguya- 0685-217272

P.O. Box 65001 Dar es Salaam

Certificate of consent
 26

I have read the foregoing information, or it has been read to me. I have had the opportunity to
ask questions and any questions that I have asked have been answered to my satisfaction. I
consent voluntarily to participate as a participant in this research.

Name of Participant__________________

Signature of Participant ___________________

Date ___________________________

Day/month/year

If Illiterate

A literate witness must sign (if possible, this person should be selected by the participant and
should have no connection to the research team). Participants who are illiterate should include
their thumb-print as well.

I have witnessed the accurate reading of the consent form to the potential participant, and the
individual has had the opportunity to ask questions. I confirm that the individual has given
consent freely.

Name of witness_____________________ AND Thumb print of participant

Signature of witness ______________________

Date ________________________
 27

Day/month/year

4.2: Fomu ya ridhaa kwa mgonjwa

MUHIMBILI UNIVERSITY OF HEALTH AND ALLIED SCIENCES

SCHOOL OF MEDICINE

DEPARTMENT OF PSYCHIATRY AND MENTAL HEALTH

 28

KICHWA CHA HABARI: UTAFITI KUHUSU MSONGO WA MAWAZO NA SABABU ZA

KIKAZI ZINAZOHUSISHWA MIONGONI MWA WAUGUZI WANAO FANYA KAZI
KATIKA HOSPITALI YA TAIFA MUHIMBILI.

Utangulizi:

Habari, naitwa Dkt. Peter Gamba mwanafunzi wa shahada ya uzamili ya udaktari wa magonjwa
na afya ya akili katika Chuo cha Sayansi Shirikishi cha Muhimbili.

Tunafanya utafiti kuhusu msongo wa mawazo na sababu za kikazi zinazohusishwa miongoni

mwa wauguzi wanao fanya kazi katika hospitali ya taifa muhimbili. Nitakupa maelezo
nakukualika kushiriki katika utafiti huu, kabla ya kuamua unaweza kuongea na mtu yeyote
kupata maelezo ya kutosha, kama kuna maneno hujaelewa vizuri unaweza kuniuliza.

Lengo la huu utafiti

Lengo kuu ni kujua ukubwa wa msongo wa mawazo na sababu za kikazi zinazohusishwa

miongoni mwa wauguzi wanao fanya kazi katika hospitali ya taifa muhimbili.

Kushiriki kutahusisha nini:

 29

Kama unakubali kushiriki katika utafiti huu, tutakuuliza maswali kuhusu mwenendo na
maendeleo ya kazi unapokuwa kazini.

Kushiriki kwako nikwahiari na baadae ukiamua kujitoa kwenye utafiti utaruhusiwa.

Usiri wa taarifa

Taarifa zote zitakazopatikana katika utafiti huu zitabaki kuwa ni siri. Tutatumia namba ya
utambulisho ya utafiti kwaajili ya kuwatambua washiriki wa utafiti, hakuna majina ya takayo
tumika katika utafiti huu au katika machapisho yoyote yakiutafiti yatakayotokana na utafiti huu
hapo baadaye. Majina yataonekana kwenye hii fomu ya ridhaa tu, ambayo itatunzwa na mtafiti,
mbali na fomu nyingine za washiriki.

Madhara ya kushiriki

Kwa kushiriki kwenye utafiti huu hautapata madhara yeyote.

Je, nitalipwa kwa ushiriki?

Kushiriki kwenye utafiti ni hiari. Hakutakuwa na malipo kwa kushiriki kwako kwenye utafiti.
Pia hautahitajika kulipia chochote ili ushiriki katika utafiti.

Kama una maswali zaidi ambayo ungependa kuuliza kuhusiana na utafiti huu, tafadhali wasiliana
na

Mtafiti Mkuu

Peter Gamba 0766- 159-460. Msimamizi wangu, Idara ya afya na magonjwa ya akili

Dr. Frank Masao 0754-288-673. Chuo Kikuu cha afya Muhimbili na pia Dr.Bruno Sunguya-
0685217272. Mwenyekiti wa kamati ya utafiti na machapisho ya chuo. S.L.P. 65001 Dar es
salaam, Tanzania

Tamko la ridhaa
 30

Mimi ………………………………………………………… nimesoma yaliyomo kwenye hii

fomu ya ridhaa, au nimesomewa yaliyomo kwenye hii fomu ya ridhaa. Maswali yangu yote
yamejibiwa nanimepewa nakala ya hii fomu ya ridhaa. Ninakubali kwahiari yangu mwenyewe
kuruhusu ndugu/jamaa yangu ashiriki katika utafiti huu

Saini ya mshiriki …………………………………. Tarehe: ………………………….

Tamko la shahidi ndugu/mlezi asiyejua kusoma au kuandika

Mimi ……………………………………………………………nimeshuhudia mgonjwa

akisomewa fomu hii ya ridhaa kwa usahihi. Ndugu/mlezi wa mgonjwa alipata nafasi ya kuuliza
maswali ambayo yote yalijibiwa. Ninathibitisha kuwa ndugu/mlezi ameruhusu kwa hiari ushiriki
wa muuguzi katika utafiti.

Saini ya shahidi ………………………….………. Tarehe: …………………….

Dole gumba la mshiriki

4.5 Questionnaire – English version

I. DEMOGRAPHIC CHARACTERISTICS OF RESPONDENT

1. Age of the interviewee in years………

2. Sex of the respondent

 31

1. Male 2. Female

3. What is your current marital status?

1. Unmarried/Single 2. Married 3. Divorced/ Separated 4. Widow 5. Cohabiting

4. What is the highest level of school you attended?

1. DIPLOMA
2. DEGREE
3. Above Degree

5. What is your monthly salary?

1. below 1M
2. 1M to 5M
3. 5M and Above

6. Rank categorization
1. Nursing officer
2. Senior Nursing officer
3. Others

7. Work experience
1. 2.5 to 5 years
2. More than 5years

8. Family number
1. Less than 4
2. 4 and above

9. Cigarette smoking
1. Smoker
 32

2. Non- smoker

II. PSYCHOSOCIAL JOB-RELATED CHARACTERISTICS

10. Job demand

1. Low

2. High

11. Job control

1. Low

2. High

12. Job satisfaction

1. Dissatisfied
2. Satisfied

13. Perceived Social Support

1. Low
2. High

14. Staff Relationship

1. Good
2. Poor

III. The CAGE Questionnaire Questions (Each of the 4 questions of the CAGE questionnaire
can be answered with a simple yes or no response).

15. Have you ever felt you should cut down on your drinking? ……….

16. Have people annoyed you by criticizing your drinking? ……….

 33

17. Have you ever felt bad or guilty about your drinking? ……….

18. Have you ever had a drink first thing in the morning to steady your nerves or get rid of a
hangover (eye-opener)?……….

SELF ADMINISTERED QUESTIONAIRE FOR ASSESMENT OF FUNCTIONAL

DISABILITY (WORLD HEALTH ORGANIZATION DISABILITY ASSESMENT
SCALE, WHODAS-12 ITEMS)

This questionnaire asks about difficulties due to health conditions. Health conditions include
diseases or illnesses, other health problems that may be short or long lasting, injuries, mental or
emotional problems, and problems with alcohol or drugs. Think back over the past 30 days and
answer these questions, thinking about how much difficulty you had doing the following
activities. For each question, please circle only one response.

(0) None (1) Mild (2) Moderate (3) Severe (4) Extreme/Cannot do.

In the past 30 days, how much difficulty did you have in.
1. Standing for long periods such as 30 minutes? [ ]
2. Taking care of your household responsibilities? [ ]
3. Learning a new task, for example, learning how to get to a new place? [ ]
4. How much of a problem did you have in joining in community activities (for example,
festivities, religious or other activities) in the same way as anyone else can? [ ]
5. How much have you been emotionally affected by your health problems? [ ]
6. Concentrating on doing something for ten minutes? []
 34

7. Walking a long distance such as a kilometer (or equivalent)? [ ]

8. Washing your whole body? []
9. Getting dressed? []
10. Dealing with people you do not know? []
11. Maintaining a friendship? []
12. Your day-to-day work? [ ]

Thank you for your cooperation and participation.

2.6 Questionnaire –Swahili version

I. MAELEZO YA JUMLA

1. Umri wa mhojiwa (miaka)............

2. Jinsia ya mhojiwa

1. Mwanaume 2. Mwanamke

3. Hali yako ya ndoa kwasasa?

1. Kuolewa 2. Ndoa 3. Talakiwa/ wametengana 4. Mjane/Mgane 5. wanaishi tu pamoja

4. Kiwango cha juu cha shule ulichohudhuria ni kipi?

1. sijasoma
2. Msingi
3. sekondari
4. Vyuo vya kati/chuo kikuu
5. uzamili / Masters

5. Unafanya shughuli ghani kwa ajili ya kipato na kujikimu?

 35

1. Mkulima

2. Biashara/Kujiajiri

3. Kuajiriwa kwa mshahara

4. Mwanafunzi 5. Hana kazi/ hafanyi kazi 6. Aliachishwa kazi baada ya kuumwa

II. TABIA ZA UGONJWA

6. Umri wa kugundulika na ugonjwa wa skizofrenia (miaka)..................

7. Muda ambao umekaa na ugonjwa (miaka)........................

8. Je, unatumia dawa yoyote kwa ya ugonjwa wa skizofrenia? Kama ndio jibu swali la 9

1. Ndiyo 2. Hapana

9. Ni dawa zipi unazotumia?

1. Antisaikotiki kizazi cha kwanza 1. Haloperidol 2. Chlopromazine 3. Fluphenazine

2. Antisaikotiki kizazi cha pili 1. Risperidone 2. Olanzanipine 3. Quetiapine
4. Trifluperazine/stelazine
3. zingine (taja).........
4. Likizo ya dawa (muda)….

10. Je, ulishawahi kupatiwa matibabu ya kisaikolojia kwa ajili ya ugonjwa wa skizofrenia? Kama
ndio jibu swali la 11

1. Ndiyo 2. Hapana

11. Ni tiba ya aina gani ya kisaikolojia uliyopatiwa?

1. Elimu ya magonjwa ya akili 2. elimu ya magonjwa ya akili na tiba nyinginezo

 36

12. Je, ulishatumia/ unatumia aina yeyote ya kilevi/ madawa ya kulevya? 1. ndiyo [ ] hapana [ ]
kama ndiyo, jibu sawali namba 13.

13. Taja aina ya dawa/ kilevi unachotumia

a. Pombe 1. Ndiyo 2. Hapana [ ]

b. Tumbaku/sigara 1. Ndiyo 2. Hapana [ ]
c. Bangi 1. Ndiyo 2. Hapana [ ]
d. Nyinginezo (taja) ………………..

14. Idadi ya mara za kulazwa kwa sababu ya ugonjwa wa skizofrenia?....................

DODOSO LA KUPIMA KIWANGO CHA ULEMAVU WA KAZI KWA WAGONJWA WA

SKIZOFRENIA KWA KUTUMIA KIPIMO CHA (WHODAS-12 ITEMS).

Dodoso hili linauliza kuhusu matatizo yanayotokana na hali ya afya. Hali ya kiafya ni pamoja na
ugonjwa au magonjwa, matatizo mengine ya kiafya ambayo yanaweza kuwa ya muda mfupi au
ya muda mrefu, majeraha, matatizo ya akili au kihisia, na matatizo ya pombe au madawa ya
kulevya. Fikiria nyuma katika siku 30 zilizopita na ujibu maswali haya, ukifikiria ni ugumu kiasi
gani ulikuwa unapata katika shughuli zifuatazo. Kwa kila swali, tafadhali chagua jibu moja tu.

(0) Hakuna (1) Kidogo (2) Wastani. (3) Sana (4) Mno/siwezi kufanya.

Katika siku 30 zilizopita, ni ugumu kiasi gani ulioupata katika;.

1. Kusimama kwa muda mrefu kama vile dakika 30? [ ]

2. Kutekeleza majukumu yako ya nyumbani? [ ]

3. Kujifunza vitu/kazi mpya, kwa mfano, kujifunza jinsi ya kufika mahali pageni? [ ]

4. Kushiriki shughuli za kijamii (kwa mfano,sherehe, shughuli za kidini au nyinginezo) kama

watu wengine? [ ]

5. Umeathiriwa kiasi gani kihisia na matatizo yako ya kiafya? [ ]

6. Kuzingatia kufanya kitu kwa dakika kumi? [ ]

 37

7. Kutembea umbali mrefu kama vile kilomita (au sawa)? [ ]

8. Kuoga mwili wako? [ ]

9. Kuvaa nguo zako? [ ]

10. Kushughulika na watu ambao hujui? [ ]

11. Kudumisha urafiki? [ ]

12. Kazi zako za kila siku? [ ]

Ahsante kwa kushiriki katika utafiti huu.

4.7 Data extraction and file screening sheet

S/N AGE SEX FINAL DIAGNOSIS ON TREATMENT
Other psychotic Mood Substances Anxiety
Schizophrenia disorders disorders related disorders disorders
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
 38

27.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.