Abstract
BACKGROUND: Nurses are the foundation of healthcare systems, providing clinical care, emotional support, health education, and patient advocacy. Their frontline role and dedication significantly enhance patient outcomes and healthcare system efficiency. However, the high-pressure nature of nursing exposes them to increased risk of mental health disorders, particularly depression, anxiety, and stress, which can undermine both personal well-being and the quality of patient care. Despite global recognition of this issue, data from resource-limited and conflict-affected settings, such as Somalia, remain scarce. This study therefore aimed to assess the prevalence of depression, anxiety, and stress symptoms and to identify associated factors among nurses in Mogadishu, Somalia. METHODS: A multicenter, cross-sectional study was conducted between November and December 2024 among 372 nurses across four hospitals in Mogadishu. Data were collected using self-administered online questionnaires comprising a demographic section, the 21-item Depression, Anxiety, and Stress Scale, the Pittsburgh Sleep Quality Index, and the Oslo Social Support Scale-3. Statistical analysis was performed using SPSS version 26, including descriptive statistics, bivariate analyses, and multivariable logistic regression. Statistical significance was set at p < 0.05. RESULTS: The prevalence of depression, anxiety, and stress symptoms among participants was 29% (95% CI: 24.5-33.9%), 32.5% (95% CI: 27.8-37.5%), and 15.1% (95% CI: 11.6-19.1%), respectively. Female was significantly associated with depression (AOR = 1.72; 95% CI: 1.01-2.92; p = 0.045) and anxiety (AOR = 1.69; 95% CI: 1.03-2.80; p = 0.040), while being over 30 years old was linked to anxiety (AOR = 2.59; 95% CI: 1.34-5.01; p = 0.005) and stress (AOR = 2.34; 95% CI: 1.09-5.02; p = 0.029). Stress was further associated with physical inactivity (AOR = 2.00; 95% CI: 1.02-3.81; p = 0.044) and ICU work assignments (AOR = 3.39; 95% CI: 1.08-10.65; p = 0.036). Notably, poor sleep quality and limited social support consistently were strongly associated with all outcomes, with adjusted odds ratios ranging from 4.60 to 8.18 for sleep and 2.46 to 3.86 for social support. CONCLUSIONS: The findings underscore a critical mental health burden among nurses in Mogadishu, driven by both occupational and personal factors. High-risk groups such as ICU staff and female nurses appear particularly vulnerable. Urgent institutional responses including regular mental health screenings, support programs (e.g., peer-support groups or employee assistance programs), workload management, and wellness promotion are essential to safeguard nurse well-being and ensure the delivery of high-quality patient care.