Descriptive Study of The Risk of Mental Health Disorders in Midwives at The Putra Medika Group Cikarang Clinic in 2022

Introduction: Mental health problems that occur in medical and health workers not only affect the quality of service and decision-making capacity which can hinder health service efforts, but have a lasting effect on their overall well-being. Objective: The purpose of this study was to describe the risk of mental health disorders in midwives at Putra Medika Group Cikarang Clinic in 2022. Method: This type of quantitative research is descriptive in nature, the research sample was all midwives at Putra Medika Group Clinic totaling 37 midwives, Result and Discussion: The results showed that of the 37 midwives, more than half of the sample, namely 30 midwives (81.1%) had normal stress. The results of anxiety showed that 14 midwives (37.8%) had normal anxiety, 10 midwives (27.0%) had severe anxiety. Conclusion: More than half of the sample, namely 30 midwives (81.1%), had depression in the normal category. As for the characteristics of the respondents, they included: 37 midwives (100%) aged <35 years, 29 midwives (78.4%) were single, and 34 midwives (91.9%) had a working period of <5 years.


Introduction
Mental health is an important aspect in realizing overall health.But in most developing countries, mental health issues have not been prioritized, compared to infectious diseases.Data from WHO in (2020) almost 1 billion people live with mental disorders, 3 million people die each year due to harmful alcohol use and 1 person dies every 40 seconds due to suicide.Today, billions of people around the world have been affected by the COVID-19 pandemic, which has further impacted people's mental health (Ridlo, 2020).
Mental disorders are prevalent in the workplace, but often go undiagnosed and do not receive attention so that workers do not get proper treatment and management, besides that sufferers are often unaware or deliberately hide their illness.It is known that there are many risk factors or hazards of work stress that have the potential to cause mental disorders known as stressors.Work stress is a cause of mental disorders in workers (Kurniawidjaja and Ramadhan, 2019).According to the Indonesian Ministry of Health in 2017, 60.6% of workers experienced depression and 57.6% of workers experienced insomnia.This disorder is associated with mental, emotional disorders and career development stressors.The cause of workplace stress is caused by workload, such as targets, interpersonal relationships with superiors or other colleagues (Bunga, Sari., 2021).
American Nurses Association (2017), states that stress in nurses is obtained as much as 82% of workers in American hospitals.According to the Health and Safety Executive (2019),it shows that health professionals, teachers, and nurses have a high level of stress with a prevalence rate of 3000 cases per 100,000 workers (Karinasari, 2022).Included in the profession of health professionals is midwives as one part of health professionals, midwives are a type of work that is close to stressful situations.This is because the risks and responsibilities of a midwife are related to the health and life safety of her patients.
Midwives may experience difficult conditions and emergencies, especially when handling maternity patients.These conditions include: bleeding, obstructed partus, eclampsia, infection, neonatal asphyxia, and others where such conditions can occur beyond the midwife's expectations.This can make midwives feel panicked, and drain energy and mind and even heart sports.That the higher the workload experienced, the higher the level of stress that can occur.If the workload exceeds the ability, it will cause fatigue both physical or mental and emotional reactions, while too little workload will cause boredom and a sense of monotony (Sembiring et al., 2022).
According to the Indonesian Ministry of Health (2017), various situations at work allow a person to experience depression.Representatives of the Indonesian Association of Occupational Medicine Specialists (Perdoki), said the condition in Indonesia, 60.6% of workers experienced depression and 57.6% experienced insomnia.Causes of stress at work are caused by workload, such as targets or deadlines, interpersonal relationships between superiors and subordinates or other colleagues.In addition, work patterns and Silvia Maya Safitri, Veza Azteria, Namira Wadjir Sangadji, Fierdania Yusvita/KESANS Descriptive Study of The Risk of Mental Health Disorders in Midwives at The Putra Medika Group Cikarang Clinic in 2022 organizational sides such as the vagueness of each employee's duties can cause stress (Karinasari, 2022).
Mental health problems that occur in medical and health workers not only affect the quality of care and decision-making capacity that can hinder the efforts of health care workers, but in particular also have a lasting effect on their overall well-being (Ridlo, 2020).The same soar to health workers can be perceived differently, that is, it can be a positive event that is not dangerous, or to be a dangerous and threatening event (Schönfeld et al., 2016).
Several studies on work stress on health workers have also been conducted related to work overload, demands for fast task processing time, lack of social support at work (especially from supervisors, head health workers and higher health workers), exposure to infectious diseases, needle pricking, and dealing with difficult patients or difficult conditions of patients who serious (UNICEF, 2020).
The impact of work stress that is not managed properly can result in high absent deism, turnover, tense work relationships, and low quality of work.From these circumstances will be able to interfere with performance and increase the risk of work accidents, and occupational diseases.The impact of occupational stress can reduce work Silvia Maya Safitri, Veza Azteria, Namira Wadjir Sangadji, Fierdania Yusvita/KESANS Descriptive Study of The Risk of Mental Health Disorders in Midwives at The Putra Medika Group Cikarang Clinic in 2022 productivity and increase workers' compensation costs.In addition, the impact of stress that is not managed properly can eliminate the sense of care for patients.
Putra Medika Clinic was established in 2006 mis one of the first health facilities (FKTP) engaged in health services that operate 24 hours a day, there are 45 health workers, namely midwives.Based on data from Putra Medika Group Clinic, patient visit data in the last 1 (one) month, namely in June 2022, the number of patient visits amounted to 9636 (nine thousand six hundred thirty-six) people consisting of patients seeking treatment, childbirth, and hospitalization.PutraMedika Clinic has an important role such as educating, seeking healing, and restoring health, and improving public health.
They are required to provide optimal service and perform tasks quickly and precisely, because Putra Medika is the first or level one health facility which is the first place to go when you want to seek treatment using BPJS.In this case, the duties of midwives include: registering new patients, conducting obstetric care including: ANC (Antenatal Care), INC (Intranasal Care), PNC (Postnatal Care), neonatal care (newborns), family planning services (family planning) making daily patient reports, checking tools, drugs and others needed, concurrently in the pharmacy, physician assistants, and swab officers.
The number of tasks carried out and the number of patients seeking treatment sometimes make midwives' working hours increase from normal working hours of 12 hours to 14 hours, sometimes when they have a day off, they must work because they change midwives who do not come to work.This can cause fatigue and excessive workload so that midwives are prone to mental health disorders that interfere with physical, psychological, and thought processes.
If the midwife experiences mental health disorders, it will have an impact on the midwife's performance during work activities such as being late in giving drugs to patients according to the appropriate hours, not focusing on what is being done, being pricked by needles, getting complaints from patients, not coming to work, until resigning.
Based on the results of interviews with HRD, it was found that in June 2022 there were 10 midwives who missed work due to illness, this could affect the overall performance of the clinic.Based on the patient satisfaction survey in June 202 2 got 20% results, patients were not satisfied with the service at Putra Medika Clinic.From the results of a preliminary study on mental health disorders in midwives by filling out the DASS-42 questionnaire, from 8 midwives it was found that 50% (4 midwives) experienced stress, from 8 midwives it was found that 100% (8 midwives) experienced anxiety and from 8 midwives obtained 12.5% (1 midwife) had depression.

Method
The study was conducted at Putra Medika Group Cikarang Clinic from July 2022 to December 2022.This study uses a descriptive method, with the aim of determining Silvia Maya Safitri, Veza Azteria, Namira Wadjir Sangadji, Fierdania Yusvita/KESANS Descriptive Study of The Risk of Mental Health Disorders in Midwives at The Putra Medika Group Cikarang Clinic in 2022 the risk picture of mental health disorders in midwives at the Putra Medika Group Cikarang Clinic in 2022.The population of this study was all midwives in Clinic Putra Medika Group which amounted to 45 midwives.
The sampling technique uses the total sampling technique, which is a sampling technique where the sample is equal to the population, the reason for taking total sampling is because the population is less than 100 people.The sample in this study was the entire population (total sampling) or as many as 37 people.The research instrument used a standard questionnaire with the Depression Anxiety Stress Scales (DASS-42) method to measure the level of mental health disorders and interviews.

Result
The results of research related to the frequency distribution of stress levels in midwives at the Putra Medika Group Cikarang Clinic in 2022 Based on table 2, it shows that the anxiety level of midwives at Putra Medika Group Cikarang Clinic as many as 14 (37.8%)midwives experience normal anxiety, then as many as 5 (13.5%) midwives experience mild anxiety, 8 (21.6%) midwives experience moderate anxiety, and 10 (27%) midwives experience severe anxiety.Based on table 4, respondents in this study were 100% under 35 years old with 78.4% of respondents unmarried and 21.6% of respondents married.Then as many as 8.1% of respondents have worked for more than 5 years and the remaining 91.9% of respondents have worked < 5 years Discussion 1.

Overview of stress levels in midwives at Putra Medika Group Cikarang Clinic in 2022
The results showed that 81.1% of midwives experienced normal stress.This is in line with research conducted by (Rosmiati, 2021) showing that as much as 91.1% of the psychological impact of Covid-19 on health workers at the Engku Haji Daud Regional General Hospital, Riau Islands Province, experienced normal stress.But even so, there are still 13.5% of midwives who experience mild stress and 5.4% of midwives who experience moderate stress.Based on the results of interviews with midwives at the Putra Medika Group Cikarang Clinic, it was said that due to the large number of patients seeking outpatient treatment and the limited number of midwives, the midwives' working hours increased from normal working hours, which is 12 hours to 14 hours, sometimes when they have a day off, they must work because they change Silvia Maya Safitri, Veza Azteria, Namira Wadjir Sangadji, Fierdania Yusvita/KESANS Descriptive Study of The Risk of Mental Health Disorders in Midwives at The Putra Medika Group Cikarang Clinic in 2022 midwives who do not come to work.In addition to this, they are also required to provide optimal service and perform tasks quickly and precisely.This can cause fatigue and excessive workload so that midwives easily experience stress that interferes with physical, psychological conditions and thought processes.So, it is necessary to take handling steps for related midwives and things that need to be considered and improved to prevent feelings of stress from arising from midwives at the Putra Medika Cikarang Clinic, because if left alone the stress experienced by midwives can affect performance while working in carrying out daily health services.In this case, there has been no effort made by the management of Putra Medika Group Cikarang Clinic regarding handling work stress.
However, the results of research on midwives at the Putra Medika Group Cikarang Clinic in 2022, stress is specifically supported by the results of a questionnaire describing question number 29 about "I find it difficult to calm down after something upsets me" showed that as many as 67.6% of midwives answered that sometimes, midwives' health workers experience stress that is influenced by the emotional demands of patients.
To prevent ongoing work stress in midwives, researchers suggest that clinics need to be proactive to maintain midwives' mental well-being such as conducting evaluations every 1 month to evaluate any obstacles or work situations that interfere with midwives' mental and psychological health and provide training to improve their skills and increase the number of midwife health workers.This stress control program aims so that the level of stress experienced by midwives does not go to the next stage of stress and midwives can carry out their work with focus and accuracy.

Overview of anxiety levels in midwives at Putra Medika Group Cikarang Clinic in 2022
The results showed that the anxiety level of midwives was dominated by the normal anxiety category, which was 37.8%.This is in line with research conducted by (Priyatna et al., 2021) showing that 83.3% of health workers during the COVID-19 pandemic at the Belitung Regency Health Center experienced normal anxiety.This is also in line with research conducted by (Rosmiati, 2021) showing that as much as 63.1% of the psychological impact of Covid-19 on health workers at the Engku Haji Daud Regional General Hospital, Riau Islands Province, experienced normal anxiety.
And also from the results of the study there are still 27% of midwives who are seriously anxious.This can be caused by various internal or external factors.As a midwife, severe anxiety can make a midwife less focus disrupt daily work, so solutions are needed in overcoming and reducing the level of anxiety of a midwife.Based on interviews with midwives, they said that the risks and responsibilities of a midwife are related to the health and life safety of patients.When experiencing difficult conditions and emergencies, especially when handling maternity patients.These conditions include: bleeding, blocked partus, eclampsia, infection, neonatal asphyxia, and others Silvia Maya Safitri, Veza Azteria, Namira Wadjir Sangadji, Fierdania Yusvita/KESANS Descriptive Study of The Risk of Mental Health Disorders in Midwives at The Putra Medika Group Cikarang Clinic in 2022 where such conditions can occur beyond the midwife's expectations.This can make midwives feel panicked, anxious, and drain the energy and mind and even exercise the heart.In this case, the management of Putra Medika Group Cikarang Clinic has not taken any effort to prevent or reduce anxiety in midwives.
The results of research on midwives at the Putra Medika Group Cikarang Clinic in 2022, anxiety was specifically supported by the results of a questionnaire describing question number 9 about "I find myself in a situation that makes me feel very anxious and I will feel very relieved if all this ends" showed that as many as 59.5% of midwives answered that sometimes, midwives health workers experience anxiety that is affected by work pressure.
Suggestions to prevent anxiety are to provide health promotion facilities to reduce ongoing anxiety that can be done in the clinic such as how to reduce anxiety with breathing relaxation techniques.

Overview of the level of depression in midwives at Putra Medika Group Cikarang Clinic in 2022
The results showed that 81.1% of midwives had normal depression.This is in line with research conducted by (Rosmiati, 2021) showing that the psychological impact of covid-19 on health workers at the Engku Haji Daud Regional General Hospital of Riau Islands Province with the result that 84.1% experienced normal depression.Based on research conducted by (Karinasari, 2022) on inpatient room nurses at Bunda Margonda Hospital Depok, the highest proportion was obtained, namely depression with normal categories with 100% results.
The results of research on midwives at the Putra Medika Group Cikarang Clinic in 2022, not experiencing depression specifically supported by the results of a questionnaire describing question number 38 about "I feel that life is meaningless" showed that as many as 89.2% of midwives answered no or never.Hasil showed that as many as 16.2% of midwives had mild depression and 2.7% of midwives had moderate depression.This suggests that there are midwives who have sufficient levels of depression to receive attention currently.If the relevant midwives do not get proper care, it will be a problem if their depression levels increase.In this case, the management of Putra Medika Group Cikarang Clinic has no intervention or efforts related to handling depression.The results of interviews with midwives at the Putra Medika Group Cikarang Clinic said midwives experience insomnia due to work fatigue where midwives sometimes work overtime, doing tasks outside their job desks such as: registering new patients, concurrently in the pharmacy, and swab officers.
Advice to prevent depression the need for midwife mental health intervention so that psychological disorders do not occur, clinics need to intervene with cognitive behavioral therapy, which is one of the counseling therapies that change negative perceptions into positive.In this case, the clinic provides counseling in the workplace so that workers can freely consult.The results of the age characteristics study are known that midwives at Putra Medika Group Cikarang Clinic have an age proportion of < 35 years (100%).Age is the length of life of an individual from the time of birth until the last birthday.
Based on hasil interviews with the management of the emen and midwives of the Putra Medika Group Cikarang Clinic, this is because in recruiting health workers the management of the Putra Medika Group Clinic has criteria or requirements in recruiting midwives health workers prioritizing midwives aged ≤ 30 years.This is because the age of < 30 years still has a good physique and stamina to work.Because someone who is young is able to do heavy work and vice versa if someone is old then the ability to do work decreases.This is possible because the aging process is a natural process.Where the old phase will be a decline in all body functions both physical and biological, so that old age is easy or susceptible to disease.Because in carrying out health services, midwives at the Putra Medika Group Clinic are required to provide fast and precise service.

Description of marital status characteristics in midwives at Putra Medika Group Cikarang Clinic in 2022
The results of the study on marital status characteristics found that 29 midwives at Putra Medika Group Cikarang Clinic were unmarried (78.4%) and 8 midwives (21.6%) were married.
Marital status can affect a person's stress level, the classification of marital status is divided into two based on the Central Statistics Agency (2013), namely married and unmarried.The effect of marital status on work stress will have a positive effect if the marriage goes well because marriage to workers can be an obstacle, accelerate or ward off the occurrence of work stress.According to research by Baghianimoghadam et al (2015), married individuals have lower stress levels compared to unmarried individuals.This happens because if workers get support in careers from their partners, the work stress they experience will tend to be lower because of the support from their partners (Sianturi et al., 2021).
Based on the results of interviews with the management and midwives of Putra Medika Group Cikarang Clinic, this is because in recruiting health workers prioritize the unmarried because so that midwife health workers are more focused on work and so as not to be often absent or allowed due to family matters.

6.
There are no characteristics of working period in midwives at Putra Medika Group Cikarang Clinic in 2022 The results of the study on the characteristics of working period are known that midwives at Putra Medika Group Cikarang Clinic, have a working period of<5 years, which is 34 midwives (91.9%) and a working period of >= 5 years as many as 3 Silvia Maya Safitri, Veza Azteria, Namira Wadjir Sangadji, Fierdania Yusvita/KESANS Descriptive Study of The Risk of Mental Health Disorders in Midwives at The Putra Medika Group Cikarang Clinic in 2022 midwives (8.1%).Working period is the period or length of labor working in a place.The working period is calculated since the occurrence of work between the company and workers.Years of service can affect the workforce both positively and negatively.Working time will have a positive influence on workers if the longer someone works, the more experience the worker has in doing his job.But on the contrary, it will have a negative influence if the longer someone works, it will cause boredom and work fatigue which leads to organ damage (Bunga, Sari., 2021).
Working period has the potential for work stress.Both long and long work periods can trigger work stress and be exacerbated by a large workload.In addition, tenure related to work stress is closely related to burnout at work, workers who have worked for more than 5 years usually have a higher level of burnout than workers who have just worked.So that the level of saturation can cause work stress (Sianturi et al., 2021).
Based on the results of interviews with management and midwives of Putra Medika Group Cikarang Clinic, this is because there are several factors that cause midwife health workers to work < 5 years at Putra Medika Group Cikarang Clinic such as: getting a job elsewhere, conflicts with colleagues, continuing education, moving domicile and personal commitments (wanting to focus on their family) so many choose to Resign from work.

Conclusion
The highest proportion of mental health disorders risk figures were midwives with normal stress levels as many as 30 respondents (81.1%), normal anxiety levels as many as 14 respondents (37.8%) and normal depression levels as many as 30 respondents (81.1%).The highest proportion of age with mental health risk was midwives aged < 35 years as many as 37 respondents (100%).
The highest proportion of marital status with a risk of mental health disorders was midwives with unmarried marital status as many as 29 respondents (78.4%).The highest proportion of working years with a risk of mental health disorders were midwives with a working length of < 5 years as many as 34 respondents (91.95%).

Table 1
Frequency distribution of stress levels in midwives at Putra Medika Group Cikarang Clinic in 2022 Frequency distribution of anxiety levels in midwives at Putra Medika Group Cikarang Clinic in 2022

Study of The Risk of Mental Health Disorders in Midwives at The Putra Medika Group Cikarang Clinic in 2022 Table 3
Silvia Maya Safitri, Veza Azteria, Namira Wadjir Sangadji, Fierdania Yusvita/KESANS Descriptive Frequency distribution of depression levels in midwives at Putra Medika GroupCikarang Clinic in 2022Based on table3, it shows that as many as 30 (81.1%) midwives at Putra Medika Group Cikarang Clinic experienced normal depression.Then as many as 6 (16.2%) midwives experienced mild depression, and as many as 1 (2.7%) midwives experienced moderate depression.

Table 4
Frequency distribution of respondent characteristics in midwives at Putra Medika Group Cikarang Clinic in 2022