The Relation Between Sleep Quality, Suicidal Thoughts & Job Efficacy Among Healthcare Workers in Public Hospitals of Kabul City

The Relation Between Sleep Quality, Suicidal Thoughts & Job Efficacy Among Healthcare Workers in Public Hospitals of Kabul City | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Relation Between Sleep Quality, Suicidal Thoughts & Job Efficacy Among Healthcare Workers in Public Hospitals of Kabul City Abdul Ahad Sultani, Bezhan Ayubi, Khwaja Zabihullah Sediqi This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5840619/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Background: Sleep quality is an important factor in the health and well-being of healthcare workers. Poor sleep quality has been associated with a number of negative outcomes, including lower job efficacy and higher suicidal thoughts. Objective: The purpose of this study was to investigate the relationship between sleep quality, suicidal thoughts and job efficacy in healthcare workers. Methods: A correlational study was conducted with a sample of 130 healthcare workers employed in governmental hospitals in Kabul City, Afghanistan. Data were collected using the Pittsburgh Sleep Quality Index (PSQI), the Job Efficacy Scale, and the Beck Scale for Suicidal Ideation (BSSI). Results: This study found that 60% of healthcare workers experience poor sleep quality, sleep quality and suicidal thoughts were interrelated but there was no significant correlation between job efficacy, suicidal thoughts and sleep quality. Poor sleep quality was associated with higher suicidal thoughts. Conclusion: The findings of this study highlight the importance of addressing sleep problems in healthcare workers. Understanding sleep quality can inform healthcare policies and interventions aimed at improving sleep quality among this population. Highlighting the correlation between sleep quality and suicidal thoughts can lead to increased awareness and prompt the development of mental health support systems within healthcare settings. Future research should investigate the effectiveness of interventions to improve sleep quality in healthcare workers. Sleep quality suicidal thoughts job efficacy healthcare workers Governmental hospital Kabul Introduction We spend about one-third of our lives sleeping [ 1 ]. Sleep is essential for conserving energy and maintaining physical well-being, and human health is related to the quantity and quality of sleep [ 2 ]. Research has shown that good sleep quality is associated with productivity and improved emotional functioning [ 3 ], [ 4 ], while disturbed sleep is associated with impaired decision-making [ 5 ], heart disease [ 6 ], and an increased risk of developing neurological disorders such as Alzheimer's disease[ 7 ]. Disturbed sleep can negatively impact cognitive function [ 8 ], academic performance [ 9 ], and overall quality of life [ 10 ]. Insomnia, sleep deprivation, and other sleep-related problems reduce sleep quality in individuals. A meta-analysis indicates a strong relationship between sleep quality and mental health [ 4 ]. Poor sleep quality is also one of the ten warning signs of suicide [ 11 ], which alone causes one death every 40 seconds worldwide. For every suicide death, there are 25 suicide attempts [ 11 ]. Identifying suicidal thoughts in individuals is crucial for predicting this phenomenon in society. Meta-analyses have found a significant association between suicidal thoughts and poor sleep quality [ 12 ]. Research has also shown a significant relationship between medical errors and poor sleep quality. [ 13 ]. It is worth noting that according to scientific reports, 20 to 30 percent of accidents in work and non-work environments are attributed to sleep-related problems and disorders. Therefore, further studies on job-related factors and sleep quality are necessary to increase organizational efficiency and obtain more accurate information. Given the growing recognition of the importance of sleep quality, this research aims to contribute to the body of knowledge by investigating the interrelationships between sleep quality, suicidal thoughts, and job performance among Afghan healthcare workers. This study seeks to clarify the prevalence and relationships of these concepts in a society where mental health information remains ambiguous However, conducting mental health research in Afghanistan presents unique cultural and systemic challenges. Cultural stigma surrounding mental health issues often discourages individuals from seeking help or participating in research. Additionally, systemic issues such as limited access to mental health resources and ongoing security concerns can hinder data collection and participant engagement [ 14 ]. The target population of this research is healthcare workers, whose sleep quality has been reported to be one and a half times worse than other individuals in society due to factors such as shift work and work pressure [ 5 ]. The impact of these factors in Afghan society can be several times greater than in other countries due to the shortage of healthcare workers. This challenge (shortage of staff) itself makes this research even more necessary. In this context, the study aims to investigate the level of sleep quality, suicidal thoughts, and job performance of healthcare workers in public hospitals in Kabul City. METHOD Participants The study included 130 healthcare workers employed in public hospitals in Kabul City. Participants were recruited using a convenience sampling method. The inclusion criteria were: Healthcare workers employed in public hospitals in Kabul City Work in one of these six positions: Docter, Nurse, Laboratory Technician, Pharmacist, Anesthesiologist or Physiotherapist . This study employed convenience sampling to ensure adequate representation of healthcare workers in Kabul's public hospitals, given the logistical and systemic challenges present in this context. While this sampling method may limit the generalizability of the findings, it is essential for gathering critical data on an understudied population. Acknowledging these limitations is crucial for interpreting the results and identifying areas for future research. Data Collection Data were collected using a structured questionnaire that included a translated version of three validated measures: The Pittsburgh Sleep Quality Index (PSQI), the Beck Scale for Suicidal Ideation (BSSI), and the Job Efficacy Scale. Each tool has demonstrated considerable reliability and validity in previous research, as well as in this study. The instruments used in this study have not been previously validated for reliability within the Afghan context. However, as detailed in the subsequent sections, all tools demonstrated acceptable reliability scores in our study, supporting their applicability in this population. Future research should aim to utilize larger samples and additional validation methods to enhance the generalizability of these findings. 1. Pittsburgh Sleep Quality Index (PSQI) The PSQI is a widely used instrument comprising 19 self-rated questions that assess various dimensions of sleep quality, including sleep duration, sleep latency, sleep efficiency, sleep disturbances, and daytime dysfunction. Originally developed by Buysse et al. [15], the PSQI has shown high internal consistency, with a Cronbach's alpha of 0.83 in the original study. In the Iranian version, the validity was reported at 0.86, and reliability at 0.89 [16]. In our research, the PSQI achieved a reliability score of 0.769, indicating acceptable reliability for this population. 2. Beck Scale for Suicidal Ideation (BSSI) The BSSI consists of 19 items that evaluate the frequency, intensity, and duration of suicidal thoughts. This scale has demonstrated strong concurrent validity, correlating highly with established clinical measures of depression and suicidal tendencies. The internal consistency reliability, evaluated using Cronbach's alpha, ranged from 0.84 to 0.97 [17]. In our study, the BSSI demonstrated a reliability score of 0.643, suggesting moderate reliability, which highlights areas for potential improvement in future studies. 3. Job Efficacy Scale The Job Efficacy Scale is composed of 5 items designed to assess a worker's belief in their ability to perform their job effectively. This scale has been validated in various studies, demonstrating reliability with a Cronbach's alpha of 0.89 [18]. In our research, the Job Efficacy Scale showed a reliability score of 0.697, which is acceptable for the context of this study. These reliability scores indicate that each tool is suitable for measuring the respective constructs in the context of healthcare workers in Kabul City, while also pointing to areas for further refinement in future research. The questionnaires were administered to participants in person at their convenience, ensuring they could complete the measures when they felt free to do so. The entire process took approximately 10-30 minutes to complete, allowing participants to provide thoughtful and accurate responses. Data Analysis The data were analyzed using descriptive statistics and Spearman correlations. Descriptive statistics were used to describe the characteristics of the sample, such as the mean age, gender, and job title of the participants. Correlations were used to examine the relationships between the variables of interest. RESULTS The sample consisted of 130 healthcare workers employed in governmental hospitals in Kabul City. The mean age of the participants was 34.05 years (SD = 10.27 years). The majority of the participants were male (69.2%). The most common job title was nurse (49.2%). Table 1 shows the demographic characteristics of the sample. Table 1 Demographic characteristics of the sample. Characteristic N (%) Age (years) 18-24 14 (10.8%) 25-34 70 (53.8%) 35-44 25 (19.2%) 45+ 21 (16.2%) Gender Male 90 (69.2%) Female 40 (30.8%) Job title Nurse 64 (49.2%) Doctor 45 (34.6%) Lab. Technician 12 (9.2%) Other 9 (6.9%) Work Schedule Day Worker 60 (46.2%) Shift Worker 70 (53.8%) Pre valence of poor sleep quality and suicidal ideation The study found a high prevalence of both poor sleep quality and suicidal thoughts among healthcare workers. The prevalence of poor sleep quality (PSQI > 5) in the sample was 60% with 78 out of 130 participants reporting poor sleep quality, while the prevalence of suicidal ideation (BSSI > 0) was 36.2%, which 47 of participants indicating some level of suicidal ideation. Table 2 shows the prevalence of poor sleep quality and suicidal ideation. Table 2 Prevalence of poor sleep quality and suicidal ideation Variable Category Count Percentage(%) Men Count(%) Women Count(%) PSQI (Sleep Quality) Good Sleep Quality (= 5) 78 60% 48(53.3%) 30(75%) Suicidal Thoughts No Suicidal Ideation (0) 83 63.8% 58(64.4%) 25(62.5%) Suicidal Ideation (> 0) 47 36.2% 32(35.6%) 15(37.5%) Job Efficacy Among Healthcare Workers This study examined job efficacy among healthcare workers, revealing significant differences in perceived efficacy levels based on gender. While a majority (57.7%) reported medium job efficacy, 36.9% reported poor efficacy (see Table 3). This disparity was further highlighted by the gender breakdown, with 37.8% of men and 35% of women reporting poor efficacy. Notably, women were more likely to report medium efficacy (62.5%) compared to men (55.6%). These findings suggest a potential gender gap in job efficacy among healthcare workers, warranting further investigation into the underlying factors contributing to this difference. Table 3 Job efficacy Variable Category Count Percentage (%) Sub-Category Count (%) Job Efficacy Poor (5-15) 48 36.9% Men 34(37.8%) Women 14(35%) Medium (16-22) 75 57.7% Men 50(55.6%) Women 25(62.5%) Very Good (+22) 7 5.4% Men 6(6.7%) Women 1(2.5%) Correlation between poor sleep quality, suicidal thoughts and job efficacy: The correlation coefficient between PSQI and suicidal thoughts was (0.328), which was significant at the (p< 0.001) level. However, the correlation coefficient between PSQI and job efficacy was (-0.147), which was not significant (p= .095). and finally, the correlation coefficient between suicidal thoughts and job efficacy (-0.145), did not show a significancy (p= 0.10). Table 4 shows the correlations numbers between mentioned variables. Table 4 Correlations between the variables of interest Variable Sleep Quality Suicidal Thoughts Job Efficacy Sleep Quality 1 .328** -.147 .000 .095 Suicidal Thoughts .328** 1 -.145 .000 .100 Job Efficacy -.147 -.145 1 .095 .100 *p < 0.05, **p < 0.01 Table 5 Independent samples t-test for gender and work schedule Subgroups Group Sample Size(%) Mean PSQI Score Standard Deviation Sig Sex Male 90(69.2%) 6.58 3.80 .145 Female 40(30.7%) 7.70 4.36 Work Schedule Non-shift 60(46.1%) 6.60 3.45 .385 Shift 70(53.8%) 7.21 4.41 The results did not show any significant difference in PSQI scores in Gender and work schedule groups. Table 5 shows the results of the independent samples t-test. Discussion According to statistics obtained from a sample of 130 healthcare workers, 78 (60%) reported poor sleep quality. This statistic indicates a twofold prevalence of sleep problems in healthcare workers compared to findings from epidemiological studies conducted in various countries [ 19 ]. This means that healthcare workers, due to poor sleep quality, are more likely to experience mental distress[ 20 ], Alzheimer's disease[ 7 ], bad impact on their long-term health [ 5 ], heart problems[ 6 ], and overall lower quality of life[ 19 ], [ 21 ]. Coelho's research in France (2023) shows that 64.8% of healthcare workers experience poor sleep quality. In contrast, Ghalichi's research in Iran [ 3 ] found a prevalence of 43% among 925 participants, while Xia's study in China [ 5 ] reported 45.1%. The observed differences in the prevalence of poor sleep quality can be attributed to two primary factors. First, a meta-analysis conducted in China revealed that studies with sample sizes smaller than 927 reported a significantly lower prevalence of sleep problems at 29.6%, compared to 65.7% in studies with larger sample sizes of over 927 healthcare workers[ 5 ]. Therefore, it can be said that if a study is conducted with a larger sample of healthcare workers, it is possible to obtain higher sleep problem rates than those reported in France. Research by Park [ 22 ] in South Korea identified staffing shortages as a key reason for decreased sleep quality among healthcare workers. He stated the shortage of staff as follows: for every 1000 people, there are 5.6 nurses, which is half the number determined by the OECD in 2014. While in Afghanistan, according to Safi's research [ 23 ], only 2.1 nurses per 10,000 people provide health services, which can also have a direct impact on the sleep quality of these workers. This study found a significant correlation (p < .001), with a correlation coefficient of 0.328, indicating that decreased sleep quality is associated with increased suicidal thoughts among healthcare workers. While the strength of this relationship was weak, meta-analyses have identified sleep disturbances as independent risk factors for suicidal thoughts, attempts, and deaths [ 11 ]. The available data indicated no significant relationship between job efficacy, suicidal thoughts, and sleep quality. This study is the first to explore the relationship between job efficacy, suicidal thoughts, and sleep quality among healthcare workers, indicating the need for further research with larger samples and diverse methodologies. Many studies have found a significant relationship between higher risk of medical errors[ 24 ], job productivity and attendance[ 25 ], job satisfaction[ 26 ], and job performance[ 27 ] with sleep quality, which are variables that can have a close relationship with job efficacy. In conclusion, this study reveals a high prevalence of poor sleep quality and a significant association with suicidal thoughts among healthcare workers in Kabul City. The findings underscore the importance of addressing sleep quality issues in this population, particularly given the cultural and systemic challenges faced in conducting mental health research in Afghanistan. Targeted interventions are needed to improve mental health outcomes in this under-researched population. Conclusion This study explored the relationships between sleep quality, job efficacy, and suicidal thoughts among healthcare workers in public hospitals in Kabul City. The findings revealed that 60% of participants reported poor sleep quality, which significantly correlates with increased suicidal thoughts (r = 0.328, p < .001). This underscores the critical need to address sleep quality issues within this population, as poor sleep is linked to various mental health challenges. Interestingly, no significant correlation was found between job efficacy and either sleep quality or suicidal thoughts, suggesting that other factors may influence job performance and mental health in this context. The lack of significant findings in this area highlights the importance of further research with larger and more diverse samples to better understand these dynamics. Given the high prevalence of poor sleep quality and its association with suicidal ideation, interventions aimed at improving sleep hygiene among healthcare workers are essential. Future studies should focus on evaluating the effectiveness of such interventions, considering the unique cultural context of Afghanistan. By enhancing sleep quality, we may not only improve the well-being of healthcare workers but also elevate the overall quality of care provided to patients. This research contributes to the growing body of knowledge on the importance of mental health and sleep quality among healthcare professionals, emphasizing the necessity for continued exploration and intervention in this field. Declarations Compliance with Ethical Standards Conflicts of Interest: All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript. Research Involving Human Participants: All procedures performed in studies involving human participants were in accordance with the ethical standards of the research committee of Faculty of Psychology and Educational Sciences, Kabul University and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed Consent: Informed consent was obtained from all individual participants included in the study Funding: No funding was received for this study. Ethical Approval: Ethics approval was obtained from the Faculty of Psychology and Educational Sciences, Kabul University, Afghanistan (IRB no. 6, 05/08/2023). (DAS) Data Availability: The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request. Author Contribution Abdul Ahad Sultani designed and conducted the study, collected the data, and wrote the initial manuscript draft. Abdul Ahad Sultani and Bezhan Ayubi performed the data analysis and interpreted the results. Bezhan Ayubi also handled the ethical approval process and supervised the entire research process. Khwaja Zabihullah Sediqi contributed to manuscript review and provided feedback on the content. All authors reviewed and approved the final manuscript. References J. M. Siegel, “Clues to the functions of mammalian sleep,” Nature , vol. 437, no. 7063, pp. 1264–1271, Oct. 2005, doi: 10.1038/nature04285. M. LeBlanc, S. Beaulieu-Bonneau, C. Mérette, J. Savard, H. Ivers, and C. M. Morin, “Psychological and health-related quality of life factors associated with insomnia in a population-based sample,” J Psychosom Res , vol. 63, no. 2, pp. 157–166, Aug. 2007, doi: 10.1016/j.jpsychores.2007.03.004. L. Ghalichi, O. Pournik, M. Ghaffari, and E. Vingard, “Sleep quality among health care workers,” Arch Iran Med , vol. 16, no. 2, pp. 100–103, Feb. 2013. A. Scott, T. Webb, M. Martyn-St James, G. Rowse, and S. 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Kessler et al. , “Insomnia and the Performance of US Workers: Results from the America Insomnia Survey,” Sleep , vol. 34, no. 9, pp. 1161–1171, Sep. 2011, doi: 10.5665/SLEEP.1230. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 11 Mar, 2025 Reviews received at journal 18 Feb, 2025 Reviews received at journal 13 Feb, 2025 Reviewers agreed at journal 13 Feb, 2025 Reviewers agreed at journal 13 Feb, 2025 Reviewers agreed at journal 05 Feb, 2025 Reviewers invited by journal 03 Feb, 2025 Editor assigned by journal 30 Jan, 2025 Submission checks completed at journal 29 Jan, 2025 First submitted to journal 16 Jan, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5840619","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":408918487,"identity":"ce4365f6-298d-41c6-8f7a-97ffe63aff2e","order_by":0,"name":"Abdul Ahad Sultani","email":"data:image/png;base64,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","orcid":"","institution":"HealthNet TPO, Afghanistan","correspondingAuthor":true,"prefix":"","firstName":"Abdul","middleName":"Ahad","lastName":"Sultani","suffix":""},{"id":408918488,"identity":"bb3a397a-bcec-4444-8fe5-56d182a63586","order_by":1,"name":"Bezhan Ayubi","email":"","orcid":"","institution":"Kabul University","correspondingAuthor":false,"prefix":"","firstName":"Bezhan","middleName":"","lastName":"Ayubi","suffix":""},{"id":408918489,"identity":"34b86597-85fc-425b-ad37-c9862d996006","order_by":2,"name":"Khwaja Zabihullah Sediqi","email":"","orcid":"","institution":"Kabul University","correspondingAuthor":false,"prefix":"","firstName":"Khwaja","middleName":"Zabihullah","lastName":"Sediqi","suffix":""}],"badges":[],"createdAt":"2025-01-16 09:38:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5840619/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5840619/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":75144549,"identity":"3bbd995a-7b37-42dc-9943-74ed34f4abf5","added_by":"auto","created_at":"2025-01-31 06:13:45","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":841654,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5840619/v1/a71e0f9c-ab54-4b65-9900-326d2a3b4cbe.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Relation Between Sleep Quality, Suicidal Thoughts \u0026 Job Efficacy Among Healthcare Workers in Public Hospitals of Kabul City","fulltext":[{"header":"Introduction","content":"\u003cp\u003eWe spend about one-third of our lives sleeping [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Sleep is essential for conserving energy and maintaining physical well-being, and human health is related to the quantity and quality of sleep [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eResearch has shown that good sleep quality is associated with productivity and improved emotional functioning [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], while disturbed sleep is associated with impaired decision-making [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], heart disease [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], and an increased risk of developing neurological disorders such as Alzheimer's disease[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDisturbed sleep can negatively impact cognitive function [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], academic performance [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], and overall quality of life [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eInsomnia, sleep deprivation, and other sleep-related problems reduce sleep quality in individuals. A meta-analysis indicates a strong relationship between sleep quality and mental health [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Poor sleep quality is also one of the ten warning signs of suicide [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], which alone causes one death every 40 seconds worldwide. For every suicide death, there are 25 suicide attempts [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Identifying suicidal thoughts in individuals is crucial for predicting this phenomenon in society. Meta-analyses have found a significant association between suicidal thoughts and poor sleep quality [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eResearch has also shown a significant relationship between medical errors and poor sleep quality. [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. It is worth noting that according to scientific reports, 20 to 30 percent of accidents in work and non-work environments are attributed to sleep-related problems and disorders. Therefore, further studies on job-related factors and sleep quality are necessary to increase organizational efficiency and obtain more accurate information.\u003c/p\u003e \u003cp\u003eGiven the growing recognition of the importance of sleep quality, this research aims to contribute to the body of knowledge by investigating the interrelationships between sleep quality, suicidal thoughts, and job performance among Afghan healthcare workers. This study seeks to clarify the prevalence and relationships of these concepts in a society where mental health information remains ambiguous\u003c/p\u003e \u003cp\u003eHowever, conducting mental health research in Afghanistan presents unique cultural and systemic challenges. Cultural stigma surrounding mental health issues often discourages individuals from seeking help or participating in research. Additionally, systemic issues such as limited access to mental health resources and ongoing security concerns can hinder data collection and participant engagement [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe target population of this research is healthcare workers, whose sleep quality has been reported to be one and a half times worse than other individuals in society due to factors such as shift work and work pressure [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The impact of these factors in Afghan society can be several times greater than in other countries due to the shortage of healthcare workers. This challenge (shortage of staff) itself makes this research even more necessary.\u003c/p\u003e \u003cp\u003eIn this context, the study aims to investigate the level of sleep quality, suicidal thoughts, and job performance of healthcare workers in public hospitals in Kabul City.\u003c/p\u003e"},{"header":"METHOD","content":"\u003cp\u003e\u003cstrong\u003eParticipants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study included 130 healthcare workers employed in public hospitals in Kabul City. Participants were recruited using a convenience sampling method. The inclusion criteria were:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eHealthcare workers employed in public hospitals in Kabul City\u003c/li\u003e\n \u003cli\u003eWork in one of these six positions: Docter, Nurse, Laboratory Technician, Pharmacist, Anesthesiologist or Physiotherapist\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThis study employed convenience sampling to ensure adequate representation of healthcare workers in Kabul\u0026apos;s public hospitals, given the logistical and systemic challenges present in this context. While this sampling method may limit the generalizability of the findings, it is essential for gathering critical data on an understudied population. Acknowledging these limitations is crucial for interpreting the results and identifying areas for future research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were collected using a structured questionnaire that included a translated version of three validated measures: The Pittsburgh Sleep Quality Index (PSQI), the Beck Scale for Suicidal Ideation (BSSI), and the Job Efficacy Scale. Each tool has demonstrated considerable reliability and validity in previous research, as well as in this study.\u003c/p\u003e\n\u003cp\u003eThe instruments used in this study have not been previously validated for reliability within the Afghan context. However, as detailed in the subsequent sections, all tools demonstrated acceptable reliability scores in our study, supporting their applicability in this population. Future research should aim to utilize larger samples and additional validation methods to enhance the generalizability of these findings.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1. Pittsburgh Sleep Quality Index (PSQI)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe PSQI is a widely used instrument comprising 19 self-rated questions that assess various dimensions of sleep quality, including sleep duration, sleep latency, sleep efficiency, sleep disturbances, and daytime dysfunction. Originally developed by Buysse et al. [15], the PSQI has shown high internal consistency, with a Cronbach\u0026apos;s alpha of 0.83 in the original study. In the Iranian version, the validity was reported at 0.86, and reliability at 0.89 [16]. In our research, the PSQI achieved a reliability score of 0.769, indicating acceptable reliability for this population.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2. Beck Scale for Suicidal Ideation (BSSI)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe BSSI consists of 19 items that evaluate the frequency, intensity, and duration of suicidal thoughts. This scale has demonstrated strong concurrent validity, correlating highly with established clinical measures of depression and suicidal tendencies. The internal consistency reliability, evaluated using Cronbach\u0026apos;s alpha, ranged from 0.84 to 0.97 [17]. In our study, the BSSI demonstrated a reliability score of 0.643, suggesting moderate reliability, which highlights areas for potential improvement in future studies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3. Job Efficacy Scale\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Job Efficacy Scale is composed of 5 items designed to assess a worker\u0026apos;s belief in their ability to perform their job effectively. This scale has been validated in various studies, demonstrating reliability with a Cronbach\u0026apos;s alpha of 0.89 [18]. In our research, the Job Efficacy Scale showed a reliability score of 0.697, which is acceptable for the context of this study.\u003c/p\u003e\n\u003cp\u003eThese reliability scores indicate that each tool is suitable for measuring the respective constructs in the context of healthcare workers in Kabul City, while also pointing to areas for further refinement in future research.\u003c/p\u003e\n\u003cp\u003eThe questionnaires were administered to participants in person at their convenience, ensuring they could complete the measures when they felt free to do so. The entire process took approximately 10-30 minutes to complete, allowing participants to provide thoughtful and accurate responses.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data were analyzed using descriptive statistics and Spearman correlations. Descriptive statistics were used to describe the characteristics of the sample, such as the mean age, gender, and job title of the participants. Correlations were used to examine the relationships between the variables of interest.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eThe sample consisted of 130 healthcare workers employed in governmental hospitals in Kabul City. The mean age of the participants was 34.05 years (SD = 10.27 years). The majority of the participants were male (69.2%). The most common job title was nurse (49.2%).\u003c/p\u003e\n\u003cp\u003eTable 1 shows the demographic characteristics of the sample.\u003c/p\u003e\n\u003cp\u003eTable 1 Demographic characteristics of the sample.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"598\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 265px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 265px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003e18-24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e14 (10.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003e25-34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e70 (53.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003e35-44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e25 (19.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003e45+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e21 (16.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 265px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e90 (69.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e40 (30.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 265px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eJob title\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003eNurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e64 (49.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003eDoctor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e45 (34.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003eLab. Technician\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e12 (9.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e9 (6.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 265px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWork Schedule\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003eDay Worker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e60 (46.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003eShift Worker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e70 (53.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003ePre\u003c/strong\u003e\u003cstrong\u003evalence of poor sleep quality and suicidal ideation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study found a high prevalence of both poor sleep quality and suicidal thoughts among healthcare workers. The prevalence of poor sleep quality (PSQI \u0026gt; 5) in the sample was 60% with 78 out of 130 participants reporting poor sleep quality, while the prevalence of suicidal ideation (BSSI \u0026gt; 0) was 36.2%, which 47 of participants indicating some level of suicidal ideation.\u003c/p\u003e\n\u003cp\u003eTable 2 shows the prevalence of poor sleep quality and suicidal ideation.\u003c/p\u003e\n\u003cp\u003eTable 2 Prevalence of poor sleep quality and suicidal ideation\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"661\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCount\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMen Count(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWomen Count(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePSQI (Sleep Quality)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003eGood Sleep Quality (=\u0026lt; 5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e40%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e42(46.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e10(25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003ePoor Sleep Quality (\u0026gt; 5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e60%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e48(53.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e30(75%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSuicidal Thoughts\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003eNo Suicidal Ideation (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e63.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e58(64.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e25(62.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003eSuicidal Ideation (\u0026gt; 0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e36.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e32(35.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e15(37.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eJob Efficacy Among Healthcare Workers\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study examined job efficacy among healthcare workers, revealing significant differences in perceived efficacy levels based on gender. While a majority (57.7%) reported medium job efficacy, 36.9% reported poor efficacy (see Table 3). This disparity was further highlighted by the gender breakdown, with 37.8% of men and 35% of women reporting poor efficacy. Notably, women were more likely to report medium efficacy (62.5%) compared to men (55.6%). These findings suggest a potential gender gap in job efficacy among healthcare workers, warranting further investigation into the underlying factors contributing to this difference.\u003c/p\u003e\n\u003cp\u003eTable 3 Job efficacy\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"623\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCount\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eSub-Category \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCount (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eJob Efficacy\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePoor (5-15)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e48\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e36.9%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMen\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e34(37.8%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWomen\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e14(35%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMedium (16-22)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e75\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e57.7%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMen\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e50(55.6%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWomen\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e25(62.5%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVery Good (+22)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e7\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5.4%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMen\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e6(6.7%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWomen\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1(2.5%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eCorrelation between poor sleep quality, suicidal thoughts and job efficacy:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe correlation coefficient between PSQI and suicidal thoughts was (0.328), which was significant at the (p\u0026lt; 0.001) level. However, the correlation coefficient between PSQI and job efficacy was (-0.147), which was not significant (p= .095). and finally, the correlation coefficient between suicidal thoughts and job efficacy (-0.145), did not show a significancy (p= 0.10).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 4 shows the correlations numbers between mentioned variables.\u003c/p\u003e\n\u003cp\u003eTable 4 Correlations between the variables of interest\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"573\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSleep Quality\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSuicidal Thoughts\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eJob Efficacy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSleep Quality\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.328**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-.147\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.095\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSuicidal Thoughts\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.328**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-.145\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eJob Efficacy\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-.147\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-.145\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.095\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e.100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\u0026nbsp;\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*p \u0026lt; 0.05, **p \u0026lt; 0.01\u003c/p\u003e\n\u003cp\u003eTable 5 Independent samples t-test for gender and work schedule\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"583\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubgroups\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSample Size(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean PSQI Score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStandard Deviation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003eSig\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e90(69.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e6.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e3.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e.145\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e40(30.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e7.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e4.36\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eWork Schedule\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eNon-shift\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e60(46.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e6.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e3.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e.385\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eShift\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e70(53.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e7.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e4.41\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe results did not show any significant difference in PSQI scores in Gender and work schedule groups.\u003c/p\u003e\n\u003cp\u003eTable 5 shows the results of the independent samples t-test.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eAccording to statistics obtained from a sample of 130 healthcare workers, 78 (60%) reported poor sleep quality. This statistic indicates a twofold prevalence of sleep problems in healthcare workers compared to findings from epidemiological studies conducted in various countries [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. This means that healthcare workers, due to poor sleep quality, are more likely to experience mental distress[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], Alzheimer's disease[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], bad impact on their long-term health [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], heart problems[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], and overall lower quality of life[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Coelho's research in France (2023) shows that 64.8% of healthcare workers experience poor sleep quality. In contrast, Ghalichi's research in Iran [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] found a prevalence of 43% among 925 participants, while Xia's study in China [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] reported 45.1%. The observed differences in the prevalence of poor sleep quality can be attributed to two primary factors. First, a meta-analysis conducted in China revealed that studies with sample sizes smaller than 927 reported a significantly lower prevalence of sleep problems at 29.6%, compared to 65.7% in studies with larger sample sizes of over 927 healthcare workers[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Therefore, it can be said that if a study is conducted with a larger sample of healthcare workers, it is possible to obtain higher sleep problem rates than those reported in France. Research by Park [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] in South Korea identified staffing shortages as a key reason for decreased sleep quality among healthcare workers. He stated the shortage of staff as follows: for every 1000 people, there are 5.6 nurses, which is half the number determined by the OECD in 2014. While in Afghanistan, according to Safi's research [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], only 2.1 nurses per 10,000 people provide health services, which can also have a direct impact on the sleep quality of these workers.\u003c/p\u003e \u003cp\u003eThis study found a significant correlation (p\u0026thinsp;\u0026lt;\u0026thinsp;.001), with a correlation coefficient of 0.328, indicating that decreased sleep quality is associated with increased suicidal thoughts among healthcare workers. While the strength of this relationship was weak, meta-analyses have identified sleep disturbances as independent risk factors for suicidal thoughts, attempts, and deaths [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe available data indicated no significant relationship between job efficacy, suicidal thoughts, and sleep quality. This study is the first to explore the relationship between job efficacy, suicidal thoughts, and sleep quality among healthcare workers, indicating the need for further research with larger samples and diverse methodologies. Many studies have found a significant relationship between higher risk of medical errors[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], job productivity and attendance[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], job satisfaction[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], and job performance[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] with sleep quality, which are variables that can have a close relationship with job efficacy.\u003c/p\u003e \u003cp\u003eIn conclusion, this study reveals a high prevalence of poor sleep quality and a significant association with suicidal thoughts among healthcare workers in Kabul City. The findings underscore the importance of addressing sleep quality issues in this population, particularly given the cultural and systemic challenges faced in conducting mental health research in Afghanistan. Targeted interventions are needed to improve mental health outcomes in this under-researched population.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study explored the relationships between sleep quality, job efficacy, and suicidal thoughts among healthcare workers in public hospitals in Kabul City. The findings revealed that 60% of participants reported poor sleep quality, which significantly correlates with increased suicidal thoughts (r\u0026thinsp;=\u0026thinsp;0.328, p\u0026thinsp;\u0026lt;\u0026thinsp;.001). This underscores the critical need to address sleep quality issues within this population, as poor sleep is linked to various mental health challenges.\u003c/p\u003e \u003cp\u003eInterestingly, no significant correlation was found between job efficacy and either sleep quality or suicidal thoughts, suggesting that other factors may influence job performance and mental health in this context. The lack of significant findings in this area highlights the importance of further research with larger and more diverse samples to better understand these dynamics.\u003c/p\u003e \u003cp\u003eGiven the high prevalence of poor sleep quality and its association with suicidal ideation, interventions aimed at improving sleep hygiene among healthcare workers are essential. Future studies should focus on evaluating the effectiveness of such interventions, considering the unique cultural context of Afghanistan. By enhancing sleep quality, we may not only improve the well-being of healthcare workers but also elevate the overall quality of care provided to patients.\u003c/p\u003e \u003cp\u003eThis research contributes to the growing body of knowledge on the importance of mental health and sleep quality among healthcare professionals, emphasizing the necessity for continued exploration and intervention in this field.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eCompliance with Ethical Standards\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest:\u0026nbsp;\u003c/strong\u003eAll authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers\u0026rsquo; bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResearch Involving Human Participants:\u0026nbsp;\u003c/strong\u003eAll procedures performed in studies involving human participants were in accordance with the ethical standards of the research committee of Faculty of Psychology and Educational Sciences, Kabul University and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed Consent:\u003c/strong\u003e Informed consent was obtained from all individual participants included in the study\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e No funding was received for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval:\u0026nbsp;\u003c/strong\u003eEthics approval was obtained from the\u0026nbsp;Faculty of Psychology and Educational Sciences, Kabul University, Afghanistan (IRB no. 6, 05/08/2023).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(DAS) Data Availability:\u003c/strong\u003e The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAbdul Ahad Sultani designed and conducted the study, collected the data, and wrote the initial manuscript draft. Abdul Ahad Sultani and Bezhan Ayubi performed the data analysis and interpreted the results. Bezhan Ayubi also handled the ethical approval process and supervised the entire research process. Khwaja Zabihullah Sediqi contributed to manuscript review and provided feedback on the content. All authors reviewed and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eJ. M. Siegel, \u0026ldquo;Clues to the functions of mammalian sleep,\u0026rdquo; \u003cem\u003eNature\u003c/em\u003e, vol. 437, no. 7063, pp. 1264\u0026ndash;1271, Oct. 2005, doi: 10.1038/nature04285.\u003c/li\u003e\n\u003cli\u003eM. LeBlanc, S. Beaulieu-Bonneau, C. M\u0026eacute;rette, J. Savard, H. Ivers, and C. M. 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Kessler \u003cem\u003eet al.\u003c/em\u003e, \u0026ldquo;Insomnia and the Performance of US Workers: Results from the America Insomnia Survey,\u0026rdquo; \u003cem\u003eSleep\u003c/em\u003e, vol. 34, no. 9, pp. 1161\u0026ndash;1171, Sep. 2011, doi: 10.5665/SLEEP.1230.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"discpsy","sideBox":"Learn more about [Discover Psychology](https://www.springer.com/44202)","snPcode":"","submissionUrl":"","title":"Discover Psychology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Sleep quality, suicidal thoughts, job efficacy, healthcare workers, Governmental hospital, Kabul","lastPublishedDoi":"10.21203/rs.3.rs-5840619/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5840619/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Sleep quality is an important factor in the health and well-being of healthcare workers. Poor sleep quality has been associated with a number of negative outcomes, including lower job efficacy and higher suicidal thoughts.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e The purpose of this study was to investigate the relationship between sleep quality, suicidal thoughts and job efficacy in healthcare workers.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A correlational study was conducted with a sample of 130 healthcare workers employed in governmental hospitals in Kabul City, Afghanistan. Data were collected using the Pittsburgh Sleep Quality Index (PSQI), the Job Efficacy Scale, and the Beck Scale for Suicidal Ideation (BSSI).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e This study found that 60% of healthcare workers experience poor sleep quality, sleep quality and suicidal thoughts were interrelated but there was no significant correlation between job efficacy, suicidal thoughts and sleep quality. Poor sleep quality was associated with higher suicidal thoughts.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e The findings of this study highlight the importance of addressing sleep problems in healthcare workers. Understanding sleep quality can inform healthcare policies and interventions aimed at improving sleep quality among this population. Highlighting the correlation between sleep quality and suicidal thoughts can lead to increased awareness and prompt the development of mental health support systems within healthcare settings. Future research should investigate the effectiveness of interventions to improve sleep quality in healthcare workers.\u003c/p\u003e","manuscriptTitle":"The Relation Between Sleep Quality, Suicidal Thoughts \u0026amp; Job Efficacy Among Healthcare Workers in Public Hospitals of Kabul City","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-31 05:41:40","doi":"10.21203/rs.3.rs-5840619/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-03-11T10:25:33+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-02-18T05:25:17+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-02-13T17:25:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"106291263318809912171666317493725353664","date":"2025-02-13T17:24:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"38926643124884916365247222771792999839","date":"2025-02-13T17:14:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"322624139316296964731846625844818679716","date":"2025-02-06T04:55:02+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-02-03T13:08:41+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-01-30T05:30:14+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-01-29T09:56:58+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Psychology","date":"2025-01-16T09:27:15+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"discpsy","sideBox":"Learn more about [Discover Psychology](https://www.springer.com/44202)","snPcode":"","submissionUrl":"","title":"Discover Psychology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"71529a76-f3fc-4548-8ab3-986ae1427d88","owner":[],"postedDate":"January 31st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-05-08T15:23:17+00:00","versionOfRecord":[],"versionCreatedAt":"2025-01-31 05:41:40","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5840619","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5840619","identity":"rs-5840619","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}