Original Article

narra j
Original Article

Mental health analysis and resilience

psychological factor during pandemic on port
health 0fficers at country and islands entry
point
Maisarah Friza2,4, Syahrul Syahrul3,5, Marty Mawarpury1
1psychology study program, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia; 2 magister disaster science, Universitas Syiah Kuala, Banda Aceh, Indonesia;
3Dr Zaionel Abidin Hospital, Banda aceh, Indonesia; 4technical implementation unit of health ministry, Sabang, Indonesia; 5Professor at Universitas Syiah Kuala, Banda Aceh,
Indonesia.

*Corresponding author: maisarahfriza27@gmail.com

Abstract
The study purpose to analyze mental health of port health officers at country and island
entry point, correlation between socio demographic data and mental health and learn
psychological resilience factors during pandemic. Mixed method study done for this
research. Qualitative design by deep interview for more detail the mental health
condition and resilience psychological factor. Quantitative design to analyze mental
health use Depression Anxiety Stress Scale (DASS-21) and correlation between socio
demographic data and mental health. Longitudinal retrospective survey was designed to
the study. Total sampling were who has been working since january 2020 to march 2023
and concerned voluntary become a research sample. Anova and Chi square test for
statistical analysis by using PSPP software. the first 2 (two) years of the pandemic were
the most difficult times they experienced. The large amount of hoax information, the fear
of being contaminated and lack understanding of how to handle Covid-19 disasters in
2020. The officer infected by Covid19 caused a lot of delegation of working hours to
health workers in 2021. Our study indicated that port health officers had 47,4%
symptoms of depression, 63,1% anxiety and 50,0% stress. There is a significant
correlation between age and depression and working time and stress. The psychological
resilience factor based on spirituality, positive emotions, official support and personal
existence.

Keywords: Mental health, resilience psychological factors, pandemic, port health

officers, covid19 impact

Introduction
Covid19 pandemic cause mental health distraction at health workers. Fatigue, psychological
disorders, stigmatization, insomnia, depression, stress and anxiety are often experienced by
frontline health workers during a pandemic (G.Anmella, 2020). Case studies in China, South
Korea, Japan and Spain state that frontline health workers are vulnerable groups for mental
health problems due to the Covid-19 pandemic (SEPB, 2020).
Wuhan psychiatric general hospital declare that frontline health workers in Wuhan
experienced moderate to severe symptoms of stress and depression during the pandemic
(SEPB, 2020). Research on 1,173 health workers at Chinese hospitals claim that frontline health
workers experienced highest mental health problems 52.6% compared to non-frontline health
workers 34% (Qi Cai, et all., 2020). A study in Turkey, on line health workers claim that 64.7%
Received: Month Date, 2023 - Accepted: Month Date, 2023 - Published online: Month Date, 2023
 Fahlevie et al. Narra J 2023; 3 (3): e[X] - http://doi.org/10.52225/narra.v3i3.[X]
Original Article

experienced symptoms of depression, 51.6% anxiety and 41.2% stress. Additional working
hours, increase the confirmed cases, lack of support, limited logistic and inadequate
competences cause psychological pressure on frontline health workers (Rumeysa, 2020).
Frontline health workers in developing and underdeveloped countries experience more
complex mental health disorders compared to developed countries (Deng Davy, 2020). An
analysis of mental health during a pandemic at Pontianak City, Indonesia claim that 57.6%
experienced symptoms of anxiety, 52.1% depression and 47.9% insomnia (Azis et al, 2020).
There many studies examining the mental health of frontline health workers in hospitals,
but similar research on health workers at the countries and islands entrance is limited. Port
health officers working 24 hours, all transportation and people entering from abroad and within
the country must be monitored to prevent disease at entry point (Health Quarantine Law No. 6,
2018). Sabang port health officers are the right sample in this study. Considering that Sabang
has a Teluk International port, Maimun Saleh airport, which often has chartered planes from
abroad to Sabang, and a domestic port which is also a tourist port, namely Balohan port.
Based on Sabang port health office performance report, there were 221.813 people who
were examined to quarantine standards in 2020, 565.732 people in 2021 and 781.385 people in
2022. The statistical data of travel density from 2020 to 2022 at Sabang present in the graph
below. 57 ships at 2020 (a blue line), 3 ships at 2021 (a red line) and 90 ships at 2022 (a green
line) reported as international arrival. 1.611 ships at 2020 (a blue line), 2.299 ships at 2021 (a
red line) and 2.406 ships at 2022 (a green line) reported as domestic arrival.

35 300

30 250
25
200
20
150
15
100
10
5 50

0 0
n ar ay ul p v B n b r r y n l g p t v c
ja fe ma ap ma ju ju au se oc no de
A ja m m
j se no
References : Sabang port health office performance report
A
international arrival data
B
domestic arrival data

The great responsibility to prevent disease at entrance (Permenkes 356, 2008), lots of
supervision according to quarantine standards (Sabang port health office performance report) is
certainly a burden at work and has an impact on mental health and psychological resilience.
During the pandemic has upended normal existence for much of the world's population
(William et all. 2020) including port health offcer. however, people differ widely in how they
respond to challenges and difficulties. The ability to withstand setbacks, adapt positively, and
bounce back from adversity is described as “resilience” (Luthar and Cicchetti, 2001).
Psychological resilience described as an individual's capacity to maintain, restore, or improve
mental health as well as being to adapt life's challenges. Self-esteem an individual who face
adversity by optimizing his potential, the social structure of the community and facilitating
recovery requires adequate social support (IOM, 2013), positive emotions can reduce stress
better and spirituality believe that God is a helper in every crisis. There are four factors that
affect psychological resilience in individuals (Resnick et al., 2011).
The study purpose to analyze mental health of port health officer at the country and island
entry point, correlation between sociodemographic data and mental health and learn
psychological resilience factors during pandemic.

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Original Article

Methods
Study design and setting
Longitudinal retrospective survey was designed to analyze mental health and resilience
psychological factor during pandemic on port health officer at the country and islands entry
point. Data was collected between Jan 2020 unil March 2023.
Mixed method study done for this research. Qualitative design by deep interview for more
detail the mental health condition and resilience psychological factor at port health officer.
Interviews with open questions were conducted to recall amemories of the work experience and
pressure from the beginning of the pandemic in 2020 to the present. The interview began by
asking the respondent's working experience during the pandemic? After the respondents
explore their experiences, then asked several more detailed questions above: 1. When was the
most difficult time to working during a pandemic? 2. Why the respondents get a psychological
pressure at work during the pandemic? 3. How the respondents solve the psychological
preasure? 4. How is the office support? 5. What is the recovering factor to solved psychological
preasure during the pandemic? 6. There is a leassons learn from the pandemic?
The mental health was analyze used Depression Anxiety Stress Scale (DASS-21). The
Depression Anxiety Stress Scale (DASS) 21 is a self-report tool containing 21 items that assess
three constructs: Depression, Anxiety, and Stress (Lovibond and Lovibond, 1995). Each
subscale includes 7 statements. Items consist of statements referring to the previous week,
respondents are asked to read these statements and rate the frequency of the negative emotions.
Ratings are made on a series of 4-point Likerttype scales from 0 (did not apply to me at all/
never) to 3(applied to me very much/ always). Higher scores indicate more severe emotional
distress. The validity and reliability of DASS21 were performed by Universitas Pattimura.
Depression, anxiety and stress scales have internal consistency. The Cronbach alpha coefficient
with a score of 0.85, 0.84 and 0.84. The Spearman-Brown coefficient with a score of 0.84, 0.83
and 0.85. The CFI and TLI values were higher than 0.90. The RMSEA and SRMR values were
less than 0.08 with loadings factor from 0.49 to 0.75 for each of the DASS-21 questionnaire
(Arjanto, Paul. 2022).
The correlation between mental health based on DASS-21 and socio demographic data will
be confirmed. Socio demographic data were collected on gender, age, education, qualification,
working time and working place.

Sample size and randomization

The Sabang port health officer is representative for health officer at the country and the islands
entry point. Sabang has an international port (Teluk Sabang port), Maimun Saleh Airport,
which frequently receives chartered flights from overseas to Sabang, and a domestic port as a
tourism port as well (Balohan Sabang port). Total sampling at Sabang port health officer done
for this study.

Participants
The inclusion criteria were who concerned voluntary become a research sample and has been
working since Januari 2020 until Maret 2023. Exclusion criteria were who not in the office
more than 1 month. The research sample that met these criteria was 38 (thirty eight) from 46
(fourty six) officer.

Statistical analysis
The results of the interviews were transcribed into text form, data familiarization, data coding,
identification of themes, interpretation and presentation of data.
Quantitative data were analysed using PSPP. In addition to descriptive statistics, we conducted
multiple linear regression analyses to identify data normality. The correlation between
psychiatric symptoms to age and working time by using ANOVA test. The correlation between
psychiatric symptoms and gender, education, qualification and working palce by using Chi
Square test. All analyses statistical significance at p-value less than 0.05.

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Original Article

Results
Characteristics of respondents
38 people participated in the study. Characteristics of the participants are presented in Table 1.
Respondent with male sex were at the highest proportion with 23 respondent (60,5%). The age
a range 45 year to 54 year at the lowest proportion with 3 respondent (7,9%) compared 25 year
to 34 year with 15 respondent (39,5%) and 35 year to 44 year with 20 respondent (52,6%). The
highest proportion respondent with undergraduate education and time of service less then 10
year with 21 respondent (55,3%). There is no significant differences between qualification with
tehnical qualification 20 respondent (52,6%) and non tehnical qualification 18 respondent
(47,4%). 22 respondent (57,9%) are work at main office and 16 respondent (42,1%) are work at
working area.

The mental health analysis

The first 2 (two) years of the pandemic were the most difficult times they experienced. The large
amount of hoax information, the fear of being contaminated and lack understanding of how to
handle Covid-19 disasters in 2020. The officer infected by Covid19 caused a lot of delegation of
working hours to health workers in 2021.
Quantitatif data from DASS-21 total and subscale scores of the sample were presented in
Table 1. Of all respondents, 18 (47,4%) had symptoms of depression, 24 (63,1%) anxiety and 19
(50,0%) stress. For depression subscale, 18,4% of the sample were reported mild depressive
symptoms, 21,1% were reported moderate, 2,6% were reported severe and 5,3% were reported
extremely severe depressive symptoms. For anxiety subscale, 28,9% of the sample were
considered to have mild anxiety symptoms, 15,8% were considered to have moderate, 10,5%
were considered to have severe and 7,9% were considered to have extremely severe anxiety
symptoms. For stress subscale, 15,8% of the sample were reported mild stress symptoms, 18,4%
were reported moderate, 13,2% were reported severe and 2,6% were reported extremely severe
anxiety symptoms. All the result were presented in Table 1

The Correlation between socio demografic data and mental health according
to DASS21 scores
According to Anova test there is a significant correlation between age and depression
(α=0,002), no significant correlation between age and anxiety (α=0,037) and age and stress
(α=0,009).
There is a significant correlation between working time and stress (α = 0,000), no
significant correlation between gender and depression (α = 0,415), gender and anxiety (α =
0,499), gender and stress (α = 0,009), education and depression (α = 0,220), education and
anxiety (α = 0,866), education and stress (α = 0,302), working time and depression (α =
0,006), working time and anxiety (α = 0,029), qualification and depression (α = 0,355),
qualification and anxiety (α = 0,535), qualification and stress (α = 0,862), working place and
depression (α = 0,727), working place and anxiety (α = 0,959) and working place and stress (α
= 0,926) according to Chi Square test. All the analysis were presented in Table 1.

Table 1. Sociodemographic characteristics, DASS21 scores, correlation between sociodemografic

data and DASS21
Variables Depression, anxiety and stress scale Total
Normal Mild Moderate Severe Extremely
n (%) n (%) n (%) n (%) Severe n (%) n %
Depression 20 (52,6) 7 (18,4) 8 (21,1) 1 (2,6) 2 (5,3) 38 100
Anxiety 14 (36,9) 11 6 (15,8) 4 (10,5) 3 (7,9) 38 100
(28,9)
Stress 19 (50,0) 6 (15,8) 7 (18,4) 5 (13,2) 1 (2,6) 38 100

Sociodemographic Depression subscale Total p-

characteristics Normal Mild Moderate Severe Extremely n (%) value
n (%) n (%) n (%) n (%) Severe n (%)
Gender 0,415

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Original Article

13 (34,2) 4 (10,5) 3 (7,9) 1 (2,6) 2 (5,3) 23 (60,5)

ale
7 (18,4) 3 (7,9) 5 (13,2) 0 (0,0) 0 (0,0) 15 (39,5)
emal
e
Education 0,220
5 (13,2) 1 (2,6) 0 (0,0) 0 (o,0) 0 (0,0) 6 (15,8)
enior
high
scho
ol
3 (7,9) 1 (2,6) 2 (5,3) 0 (o,0) 0 (0,0) 6 (15,8)
iplo
ma
9 (23,7) 5 (13,2) 6 (15,8) 0 (0,0) 1 (2,6) 21 (55,3)
nder
grad
uate
Magister 3 (7,9) 0 (0,0) 0 (0,0) 1 (2,6) 1 (2,6) 5 (13,2)
0,355
ualifi
catio
n
9 (23,7) 5 (13,2) 4 (10,5) 0 (0,0) 2 (5,3) 20 (52,6)
ehni
cal
11 (28,9) 2 (5,3) 4 (10,5) 1 (2,6) 0 (0,0) 18 (47,4)
on
tehni
cal
Work placement 0,727
Main office 13 (34,2) 3 (7,9) 4 (10,5) 1 (2,6) 1 (2,6) 22 (57,9)
7 (18,4) 4 (10,5) 4 (10,5) 0 (0,0) 1 (2,6) 16 (42,1)
orkin
g
area
Age

Working time

Anxiety subscale Total p-

value
Normal Mild Moderate Severe Extremely n (%)
n (%) n (%) n (%) n (%) Severe n (%)
Gender 0,499
9 (23,7) 5 (13,2) 4 (10,5) 2 (5,3) 3 (7,9) 23 (60,5)
ale
5 (13,2) 6 (15,8) 2 (5,3) 2 (5,3) 0 (0,0) 15 (39,5)
emal
e
Education 0,866
4 (10,5) 1 (2,6) 1 (2,6) 0 (0,0) 0 (0,0) 6 (15,8)
enior
high
scho
ol
2 (5,3) 2 (5,3) 1 (2,6) 0 (0,0) 1 (2,6) 6 (15,8)
iplo
ma
7 (18,4) 7 (18,4) 3 (7,9) 3 (7,9) 1 (2,6) 21 (55,3)
nder
grad
uate
1 (2,6) 1 (2,6) 1 (2,6) 1 (2,6) 1 (2,6) 5 (13,2)
Magi
ster

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Original Article

Qualification 0,535
5 (13,2) 6 (15,8) 4 (10,5) 3 (7,9) 2 (5,3) 20 (52,6)
ehni
cal
9 (23,7) 5 (13,2) 2 (5,3) 1 (2,6) 1 (2,6) 18 (47,4)
on
tehni
cal
Working place 0.535
Main office 9 (23,7) 6 (15,8) 3 (7,9) 2 (5,3) 2 (5,3) 22 (57,9)
5 (13,2) 5 (13,2) 3 (7,9) 2 (5,3) 1 (2,6) 16 (42,1)
orkin
g
area
Age

Working time

Stress subscale Total p-

value
Normal Mild Moderate Severe Extremely n (%)
n (%) n (%) n (%) n (%) Severe n (%)
Gender
23 (60,5)
ale
15 (39,5)
emal
e
Education 0,302
5 (13,2) 0 (0,0) 1 (2,6) 0 (0,0) 0 (0,0) 6 (15,8)
enior
high
scho
ol
3 (7,9) 1 (2,6) 1 (2,6) 1 (2,6) 0 (0,0) 6 (15,8)
iplo
ma
10 (26,3) 5 (13,2) 3 (7,9) 3 (7,9) 0 (0,0) 21 (55,3)
nder
grad
uate
Magister 1 (2,6) 0 (0,0) 2 (5,3) 1 (2,6) 1 (2,6) 5 (13,2)
Qualification 0,862
9 (23,7) 3 (7,9) 4 (10,5) 3 (7,9) 1 (2,6) 20 (52,6)
ehni
cal
10 (26,3) 3 (7,9) 3 (7,9) 2 (5,3) 0 (0,0) 18 (47,4)
on
tehni
cal
Working place 0,926
Main office 11 (28,9) 3 (7,9) 4 (10,5) 3 (7,9) 1 (2,6) 22 (57,9)
8 (21,1) 3 (7,9) 3 (7,9) 2 (5,3) 0 (0,0) 16 (42,1)
orkin
g
area
Age

Working time

All data pass the normality requirements (regresi test).

* Chi Square test
**Anova test

The psychological resilience factors

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Original Article

The psychological resilience factor of Sabang port health officer is based on spirituality, positive
emotions, official support and personal existence. Logistics and incentive support had a
meaningful contribution to work environment for port health officer. There are a lessons learn
from this pandemic, like more concerned about health, possitive thinking to Allah ang being
prepared for another health disaster.

Discussion
The first 2 (two) years of the pandemic were the most difficult times they experienced. The large
amount of hoax information, the fear of being contaminated and lack understanding of how to
handle Covid-19 disasters in 2020. The officer infected by Covid19 caused a lot of delegation of
working hours to health workers in 2021. According to depression, anxiety, stress levels of
physicians and associated factors in Covid-19 pandemics research declare that increased
working hours, confirmed cases, lower of support during Covid-19 pandemic be an mental
health affecting factors (Rumeysa, 2020). Most of port health officer claim they was adapted in
2022 and was familiar at 2023 to working at pandemic. Defined as adapting to changes caused
by stressful events in a flexible way and recovering from negative emotional experiences
(Tugade & Fredrickson, 2004).
During the pandemic, officer mental health experienced mild to extremely severe
depression, anxiety and stress symptoms. The result aligned with psychological distress in the
general population has been reported in China during the Covid-19 quarantine (General
Hospital Psychiatry), Unravelling potential severe psychiatric repercussions on healthcare
professionals during the Covid19 crisis (Journal of Affective Disorders), Prevalence of
depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: a
systematic review and meta-analysis (Sofia papa), Depression, anxiety, stress levels of
physicians and associated factors in Covid-19 pandemics (Rumeysa), Working in the Times of
COVID-19. Psychological Impact of the Pandemic in Frontline Workers in Spain (Rogio) and
many others.
There is a significant correlation between age and depression similar to research
(masukkan references). References dulu baru There is a significant correlation working time
and stress
The psychological resilience factor of Sabang port health officer is based on spirituality,
positive emotions, official support and personal existence. Logistics and incentive support had a
meaningful contribution to work environment for port health officer. There are a lessons learn
from this pandemic, like more concerned about health, possitive thinking to Allah ang being
prepared for another health disaster.

Conclusion
Providing mental health and psychological resilience factor on port health officer at the country
and island entry point is crucial for ensuring the sustainability of prevent and protect a health
disasters at nation and islands enteraces. Our findings show that the first 2 (two) years of the
pandemic were the most difficult times they experienced. The large amount of hoax
information, the fear of being contaminated and lack understanding of how to handle Covid-19
disasters in 2020. The officer infected by Covid19 caused a lot of delegation of working hours to
health workers in 2021. Our study indicated that port health officer had symptoms of
depression, anxiety stress. There is a significant correlation between age and depression and
working time and stress. The psychological resilience factor of Sabang port health officer is
based on spirituality, positive emotions, official support and personal existence.

Ethics approval
This research was approved by the Health Research Ethics Committee of Dr. Moewardi Hospital
Surakarta prior to conducting the study (No 523/23/2022).

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Competing interests
The authors declare that there is no conflict of interest.

Acknowledgments
We thank the port health officer who concerned voluntary become a research sample

Funding
This work was supported by Indonesia Non (state budget) APBN funds.
(186.1/UN27.22/PT.01.01/2023).

Underlying data
Derived data supporting the findings of this study are available from the first author on request.

How to cite
Fahlevie F, Apriningsih H, Sutanto YS, et al. Differences in interleukin-6, tumor necrosis factor-
α, procalcitonin levels, and length of hospital stay in acute exacerbations of COPD patients with
and without secretome supplementation. Narra J 2023; 3 (3): e[X] -
http://doi.org/10.52225/narra.v3i3.[X].

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REQUIREMENTS
EMAIL OF ALL AUTHORS
Fahlevie Fahlevie : aa@gmail.com
Hendrastutik Apriningsih : aa@gmail.com
Yusup S. Sutanto : aa@gmail.com
Reviono Reviono : aa@gmail.com
Artrien Adhiputri : aa@gmail.com

PHONE NUMBER OF CORRESPONDING AUTHOR OR THE PERSON WHO RESPOSIBLE

FOR ALL COMMUNICATION: 085313XXX

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