Mental Health Outcomes and Work Performance Among Healthcare Frontline Workers in Post-Conflict Communities in Borno State

Healthcare workers in post-conflict zones face compound occupational stressors including ongoing insecurity, resource scarcity, mass casualty exposure, and organizational dysfunction, with significant implications for mental health and clinical performance. This study examined mental health outcomes and their relationship with work performance among frontline healthcare workers in post-conflict local government areas of Borno State, North East Nigeria. An analytical cross-sectional design with a qualitative component was employed, recruiting 260 health workers from primary health centers and general hospitals in Maiduguri, Bama, and Konduga. Mental health was assessed using the General Health Questionnaire-28 and the PTSD Checklist for DSM-5. Work performance was measured using a validated supervisor-rated clinical performance scale. Psychological distress was detected in 64.2 percent of respondents, with PTSD criteria met by 29.2 percent. Work performance scores were significantly lower among workers with PTSD (p less than 0.001), and the relationship was partially mediated by burnout. Qualitative data revealed compound grief, moral injury, and survival guilt as occupationally specific stressors not captured by quantitative tools. Resilience factors including peer support and religious coping moderated the mental health-performance relationship. This study contributes evidence on the occupational mental health-performance nexus in crisis contexts and recommends psychological first aid programs, trauma-informed supervision, mental health support units within Borno State health facilities, and WHO-aligned recovery support protocols. Keywords: mental health, post-conflict, healthcare workers, PTSD, Borno State.