Prevalence and determinants of occupational stress among healthcare workers at Bo Government Hospital, Sierra Leone: a cross-sectional study

Abstract

Background Occupational stress is a major determinant of healthcare worker wellbeing and health-system performance, yet empirical data from Sierra Leone's provincial referral hospitals are almost entirely absent. This study determined the prevalence of occupational stress, identified the predominant stressors, and examined the individual and occupational factors independently associated with high occupational stress among healthcare workers at Bo Government Hospital, Southern Province, Sierra Leone. Methods A descriptive cross-sectional study was conducted among 260 healthcare workers recruited by stratified proportionate random sampling from nursing, medical, laboratory, pharmacy, allied health, and administrative cadres. Occupational stress was measured using the validated 10-item Perceived Stress Scale (PSS-10) and organisational stressors using the Health and Safety Executive (HSE) Management Standards Indicator Tool. Data were analysed in SPSS v26 using descriptive statistics, Pearson's chi-square tests, and binary logistic regression; adjusted odds ratios (AOR) with 95% confidence intervals (CI) were reported, with statistical significance set at p < 0.05. Results The prevalence of high occupational stress (PSS-10 ≥ 27) was 38.5% (95% CI: 32.6–44.7), with a further 47.3% reporting moderate stress; the mean PSS-10 score was 21.4 (SD 6.8). Nurses recorded the highest prevalence of high stress (42.0%). The most frequently reported stressors were understaffing and high workload (87.3%), inadequate equipment and supplies (82.1%), and long or irregular working hours (79.6%). In the adjusted model, working more than 48 hours per week (AOR 3.05, 95% CI 1.89–4.91), low perceived job control (AOR 2.78, 95% CI 1.65–4.68), low-salary satisfaction (AOR 2.60, 95% CI 1.55–4.37), and nursing cadre (AOR 2.31, 95% CI 1.42–3.76) were the strongest independent predictors of high occupational stress. Conclusions Occupational stress is highly prevalent and structurally driven among healthcare workers at Bo Government Hospital. Modifiable, system-level determinants excessive working hours, low job control, poor remuneration and understaffing should be prioritised through enforced working-hour limits, participatory management, improved remuneration and adequate staffing to protect workforce wellbeing.