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Exploring the magnitude and predictors of the long-term psychological impact of COVID-19 on frontline healthcare workers in Vietnam: a multi-center, cross-sectional study

BMC Health Services Research volume 25, Article number: 553 (2025) Cite this article

Abstract

Background

The detrimental impacts of COVID-19 on the mental well-being of frontline healthcare workers (HCWs) have been well studied. However, the long-term trajectory of their mental well-being remains relatively unexplored. We examined the magnitude and predictors of the psychological impact of COVID-19 on frontline HCWs during the transition into the “new normal” phase.

Methods

A cross-sectional survey was performed on frontline HCWs at two largest designated COVID-19 hospitals in Ho Chi Minh City between May and November 2022. A self-administered questionnaire captured participants’ demographic characteristics and psychological distress including depression, anxiety, and insomnia. Multivariable logistic regression models were used to examine factors associated with psychological distress.

Results

Among 462 HCWs, 85.3% self-reported having good, very good, or excellent mental health before their COVID-19 deployment, compared to 40.7% during the deployment and 55.6% at the time of the study. The prevalence of moderate-to-severe depression was 26.8%, anxiety (20.8%), insomnia (23.4%), and overall psychological distress (73.2%). Predictors for depression included pre-existing physical (adjusted odds ratio [aOR] = 2.09, 95%CI 1.03–4.22, P = 0.04) and mental health (aOR = 3.59, 95%CI 1.31–9.84, P = 0.01) conditions and being deployed during the 3rd (aOR = 6.28, 95%CI 1.12–35.08, P = 0.04) and 4th (aOR = 5.01, 95%CI 1.08–23.16, P = 0.04) COVID-19 wave. Those with mental health conditions before the deployment (aOR = 3.95, 95%CI 1.42–11.0, P = 0.008) were more likely to report anxiety symptoms. Predictors for insomnia included physical health conditions before the deployment (aOR = 2.73, 95%CI 1.37–5.44, P = 0.004), working at field hospitals (aOR = 2.44, 95%CI 1.43–4.16, P = 0.001), and currently being deployed to respond to COVID-19 (aOR = 0.35, 95%CI 0.19–0.67, P = 0.001).

Conclusions

Given the substantial impact of COVID-19 deployment on HCWs’ long-term mental well-being, comprehensive mental health support strategies are urgently needed. As HCWs may overlook their mental health issues, a screening program with psychological support services should accompany them early in future pandemics. Further nationwide studies with longer follow-ups are necessary to understand the full extent of psychological distress among frontline HCWs in Vietnam.

Peer Review reports

Background

Frontline healthcare workers (HCWs) have played a key role in the responses to COVID-19. It is widely acknowledged that large-scale health crises like the COVID-19 pandemic represent a profound challenge to individuals across different age groups and cultures, including frontline HCWs who are particularly vulnerable to enduring mental health issues [1]. This is likely due to their heightened personal and work-related stresses, as well as their new experiences of risk, uncertainty, and vulnerability associated with a new disease [2]. Several studies have revealed high rates of pre-existing mental health distress among HCWs which can worsen during the COVID-19 pandemic [3,4,5,6]. Globally, the negative impact of frontline health work on HCWs’ mental health including depression, anxiety, insomnia, and burnout, has been extensively studied during the peak of the pandemic [7,8,9,10,11,12,13,14,15,16,17]. Interestingly, Asian HCWs experience less profound psychological distress compared to their Western counterparts during COVID-19 [18], which could be attributed to potential under-reporting in the Asian context due to the local prevalent stigma surrounding mental illness [19]. Therefore, further investigation is needed to understand the enduring mental health issues acquired by Asian frontline HCWs so that interventions could be tailored.

Given the evident psychological impact experienced by HCWs during the peak of the COVID-19 pandemic, there has been growing concern regarding long-term health consequences for this vulnerable population. Lessons learnt from the SARS outbreak in Canada highlight that HCWs continued to endure high levels of burnout, psychological distress, and post-traumatic stress for an extended period of 13 to 26 months after the end of the outbreak [20]. Yet, there is limited knowledge about the analogous effects in the context of COVID-19, which represents the most recent global health crisis. A study conducted in Australia between November 2020 to 31 January 2021 found that frontline HCWs’ mental health was notably improved compared to around 10 months earlier during the initial surge of COVID-19 in March 2020 [21]. However, their mental health had not fully returned to the pre-pandemic levels, even during this period when Australia experienced a relatively low number of COVID-19 cases and deaths [21]. Hence, these findings may not accurately reflect the true impact of COVID-19 on changes in mental health of HCWs in other settings over time, especially in countries more heavily affected by the pandemic with comparatively fewer resources, such as Vietnam.

In Vietnam, the first cases of COVID-19 were reported in January 2020, followed by three subsequent COVID-19 waves that were effectively controlled [22]. However, in April 2021, Vietnam experienced its fourth surge of COVID-19, marked as the first significant outbreak [23]. During this surge and subsequent waves, Vietnam had comparably high numbers of cases and deaths on an international scale [24]. Despite facing these challenging circumstances, the long-term psychological impact of COVID-19 on frontline HCWs remains unknown. Therefore, this study examined the magnitude and predictors of psychological distress of COVID-19 on frontline HCWs during the transition into the “new normal” phase. These HCWs included physicians, nurses and other health professionals who were previously deployed to respond to the most severe outbreaks of COVID-19 in southern Vietnam. The study findings will provide valuable insights that help inform best practices for safeguarding the mental health of frontline HCWs during future pandemics.

Methods

Study context, design, and participants

Ho Chi Minh City in Vietnam emerged as the epicenter of the fourth surge of COVID-19 [23], with significant spread and impact in this area [25]. The city faced a prolonged lockdown from May 31 to October 1, 2021, as a response to the outbreak [26]. The Hospital for Tropical Diseases (HTD), a 550-bed hospital located in Ho Chi Minh City, is the largest and leading tertiary teaching hospital for infectious diseases in southern Vietnam. Since early 2020, HTD had been actively involved in treating COVID-19 patients and had become the largest COVID-19-designated hospital since June 2021 [27]. In addition, during the peak of COVID-19 outbreaks, HTD managed the COVID-19 Field-hospital No. 14 in Ho Chi Minh City [28]. Other local public and private hospitals periodically mobilized their HCWs to support the operations of this field hospital.

This multi-center, cross-sectional study was conducted between May 25 and November 25, 2022, which marked approximately two years and four months after the initial major wave of COVID-19 and seven months of the “new normal” in Vietnam [29], without ongoing COVID-19 outbreak and the cessation of lockdowns in the city. The inclusion criterion was HCWs who were deployed to respond to COVID-19. In detail, they were responsible for the care of COVID-19 patients at the study clinics, regardless of their professional roles. Hence, all HCWs, including 440 staff at HTD and 125 staff at COVID-19 Field-hospital No. 14 were invited to participate in the study. An exclusion criterion was potential study participants who refused to participate in this study. The study was approved by Ethics Committees of Nam Dinh University of Nursing (approval number 1270/GCN-HĐĐĐ) and HTD (approval number 2519/QĐ-BVBNĐ). Written informed consent was obtained from all study participants.

Data collection

A self-administered questionnaire was used to collect study participants’ information and was composed of three sections: demographic and general information, mental health self-assessment, and impact of the COVID-19 deployment on mental health including depression, anxiety, and insomnia (Appendix 1).

Demographic and general information section: comprised of 18 questions including four questions related to demography, four questions concerning their profession, two questions pertaining to physical and mental health status prior to deployment, seven questions regarding COVID-19, and one question about previous experience in responding to infectious disease outbreak.

Mental health self-assessment: Included three Likert scale questions with six options corresponding to the levels of health status from “very poor” to “excellent”. Based on these questions, study participants were asked to self-assess their mental health status at the time of the study. They were also asked to retrospectively think about their status before and during the COVID-19 deployment. Depression severity: was assessed using the Patient Health Questionnaire with 9 items (PHQ- 9) [30]. The total score is interpreted as follows: 0–4 (minimal), 5–9 (mild), 10–14 (moderate), 15–19 (moderately severe), and 20–27 (severe). As depression is defined as having a PHQ- 9 score of ≥ 10 [31], participants’ scores were dichotomized into two groups: 0–9 (none-to-mild depression) and 10–27 (moderate-to-severe depression).

Anxiety severity: was evaluated using the Generalized Anxiety Disorder 7-item scale (GAD- 7) [32]. The GAD- 7 score is classified into four groups: 0–4 (minimal), 5–9 (mild), 10–14 (moderate), and 15–21 (severe). Since anxiety is defined as having a GAD- 7 score of ≥ 10 [33], participants were further classified into two groups: 0–9 (none-to-mild anxiety) and 10–21 (moderate-to-severe anxiety).

Insomnia severity: This study used the Insomnia Severity Index (ISI) [34] categorized into: 0–7 (no clinically significant insomnia), 8–14 (subthreshold insomnia), 15–21 (clinical insomnia – moderate insomnia), and 22–28 (clinical insomnia – severe insomnia). Since clinical insomnia is defined as having an ISI score of ≥ 15 [35], participants were dichotomized into two groups: 0–14 (none-to-subthreshold insomnia) and 15–28 (moderate-to-severe insomnia).

The use of these scales to quantify the psychological impact of COVID-19 on frontline HCWs has been validated elsewhere [15, 36, 37]. In Vietnam, these scales have been translated into Vietnamese and tested for reliability and validity [38,39,40].

Statistical analysis

Data management and analysis were performed using the Statistical Package for Social Sciences (SPSS) software version 26. Categorical variables were presented as frequencies and percentages, while continuous variables were described using means with a standard deviation (SD) and range. To assess the impact of COVID-19 deployment on HCWs’ mental health, the overall moderate-to-severe psychological disorder was calculated and defined as a condition in which a participant had been classified as having any of the moderate-to-severe anxiety, depression, and insomnia [41]. In contrast, the overall non-psychological disorder was defined as a condition in which a participant had been classified as not having anxiety, depression, or insomnia. The overall mild psychological disorder included those who were not listed in these two groups. Student’s t-test was used to compare continuous data, and chi-squared and univariable logistic regression models were used to compare categorical variables. Multivariable logistic regression models were deployed to examine predictors of depression, anxiety, and insomnia individually and included variables whose P value < 0.25 in univariate analysis [42]. A significant level of 0.05 was used.

Results

Baseline characteristics of study participants

Among all 440 staff at the HTD and 125 staff at COVID-19 Field-hospital No.14, 355 (80.7%) and 107 (85.6%) agreed to participate in and completed the study respectively, making the total study population of 462 (81.8%) (Fig. 1).

Fig. 1
figure 1

Flowchart of study participants

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Among 462 study participants, the mean age was 35 ± 7.3 years old. Men accounted for 44.4% (205/462), and 42.6% (197/462) lived with their partner and children (Table 1). About 92.2% (426/462) worked for public hospitals, and 64.7% (299/462) had a permanent contract with their workplace. Approximately half (50.6%, 234/462) of participants completed a Bachelor’s degree, 45.5% (210/462) were physicians and 36.6% (169/462) were clinical nurses. Regarding the main workplace, 32.7% (151/462) and 24% (111/462) worked at inpatient departments and intensive care units (ICUs), respectively. The mean career duration was 10.5 ± 7.2 years. Most participants did not have any chronic physical health condition (89.2%, 412/462) or mental health issues (95.7%, 442/462) before their COVID-19 deployment. Nearly all (93.7%, 433/462) participants reported previously having COVID-19 or knew someone who had it. Most (97.6%, 451/462) participants were deployed in Ho Chi Minh City and around two-thirds (63.9%, 295/462) worked at COVID-19 field hospitals. Participants mainly managed severely ill patients (63.8%, 295/462). The mean deployment time was 6.5 ± 5.6 months. Only 15.2% (70/462) had previous infectious disease outbreak response experience. At the time of the study, less than one-third (30.1%, 139/462) of participants were still working in the frontline settings.

Table 1 Baseline characteristics of frontline healthcare workers in Vietnam: 2022
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Study participants’ mental health self-assessment

Before their COVID-19 deployment, most participants (85.3%, 394/462) self-reported having good, very good, or excellent mental health compared with 40.7% (188/462) when being deployed to respond to COVID-19 and 55.6% (257/462) at the time of the study, respectively (Fig. 2).

Fig. 2
figure 2

Mental health self-assessment among frontline healthcare workers in Vietnam: 2022

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Frequency of depression, anxiety, insomnia, and overall psychological distress among study participants at the time of the study

The prevalence of moderate-to-severe depression, anxiety, and insomnia was 26.8% (124/462, 95%CI 22.9–31.2%), 20.8% (96/462, 95%CI 17.2–24.8%), and 23.4% (108/462, 95%CI 19.7–27.6%), respectively (Fig. 3). The prevalence of overall moderate-to-severe psychological distress was 36.8% (170/462, 95%CI 32.4–41.4%) and overall psychological distress was 73.2% (338/462, 95%CI 68.8–77.1%).

Fig. 3
figure 3

Distribution of severity levels of psychological distress among frontline healthcare workers in Vietnam: 2022

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Associations between baseline characteristics and moderate-to-severe depression, anxiety, and insomnia among study participants at the time of the study

There was a statistically significant association between moderate-to-severe depression and having physical health conditions (OR = 1.97, 95%CI 1.01–3.77, P = 0.03) and mental health conditions (OR = 4.41, 95%CI 1.61–12.76, P < 0.001) before being deployed to respond to COVID-19 as well as previous infectious disease outbreak response experience (OR = 0.46, 95%CI 0.21–0.93, P = 0.02) (Table 2).

Table 2 Unadjusted predictors tested for moderate-to-severe depression among frontline healthcare workers in Vietnam: 2022
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There was a statistically significant association between moderate-to-severe anxiety and having physical health conditions (OR = 2.17, 95%CI 1,08–4,24, P = 0.01) and mental health conditions (OR = 3.39, 95%CI 1.18–9.15, P = 0.006) before being deployed to respond to COVID-19 (Table 3).

Table 3 Unadjusted predictors tested for moderate-to-severe anxiety among frontline healthcare workers in Vietnam: 2022
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There was a statistically significant association between moderate-to-severe insomnia and age (P < 0.001), duration of working as a health professional (P < 0.001), having physical health conditions before being deployed to respond to COVID-19 (OR = 2.98, 95%CI: 1.54–5.69, P < 0.001), deployment at field hospitals (OR = 2.09, 95%CI 1.25–3.56, P = 0.003), and currently being deployed to respond to COVID-19 (OR = 0.33, 95%CI 0.17–0.59, P < 0.001) (Table 4).

Table 4 Unadjusted predictors tested for moderate-to-severe insomnia among frontline healthcare workers in Vietnam: 2022
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Models for the prediction of moderate-to-severe depression, anxiety, and insomnia among study participants

Predictors for moderate-to-severe depression included physical (aOR = 2.09, 95%CI 1.03–4.22, P = 0.04) and mental health (aOR = 3.59, 95%CI 1.31–9.84, P = 0.01) conditions before being deployed to respond to COVID-19, being deployed during the 3rd (aOR = 6.28, 95%CI 1.12–35.08, P = 0.04) and 4th (aOR = 5.01, 95%CI 1.08–23.16, P = 0.04) COVID-19 wave (Table 5). Regarding moderate-to-severe anxiety, the only predictor for this condition was having mental health conditions before being deployed to respond to COVID-19 (aOR = 3.95, 95%CI 1.42–11.0, P = 0.008). Predictors for moderate-to-severe insomnia included physical health conditions before being deployed to respond to COVID-19 (aOR = 2.73, 95%CI 1.37–5.44, P = 0.004), COVID-19 deployment at field hospitals (aOR = 2.44, 95%CI 1.43–4.16, P = 0.001), and currently being deployed to respond to COVID-19 (aOR = 0.35, 95%CI 0.19–0.67, P = 0.001).

Table 5 Multivariable logistic regression analysis for predictors of moderate-to-severe depression, anxiety, and insomnia among frontline healthcare workers in Vietnam: 2022
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Discussion

Despite the abundance of studies investigating the immediate mental health impact of COVID-19 on frontline HCWs [7,8,9,10,11,12,13,14,15,16,17], there remains a scarcity of information on the long-term psychological impact of COVID-19 deployment. This study represents the first investigation into the long-term impact of COVID-19 deployment on the mental well-being of frontline HCWs who previously responded to the most severe outbreaks of COVID-19 in southern Vietnam. Our study suggests a significant decline in the overall mental well-being of frontline HCWs as they faced the challenges and stressors associated with their COVID-19 deployment. Particularly, prior to being deployed to respond to the COVID-19 pandemic, a majority of participants (85.3%) self-reported having good, very good, or excellent mental health. However, this number declined to 40.7% during their deployment to respond to the peak of the COVID-19 pandemic and slightly increased to 55.6% at the time of the study. Prior studies have documented the burden of frontline HCWs’ psychological distress during the peak of the pandemic [7,8,9,10,11,12,13,14,15,16,17], and there has been suboptimal improvement in HCWs’ self-rated mental health after the surge of COVID-19 has also been recorded [21]. Our results underscore the psychological toll experienced by HCWs who were at the forefront of the COVID-19 response. Given the limitation in our quantitative data, incorporating qualitative research methods could further enhance our understanding of the long psychological impact of COVID-19 deployment on frontline HCWs. Such research could provide invaluable insights into the unique experiences, coping mechanisms, and challenges faced by HCWs during their deployment.

In addition, based on the standardized PHQ- 9 [30], GAD- 7 [32], and ISI [34] scales, we found that at the time of the study, the HCWs’ combined overall rates of psychological distress of 73.2% were higher than the self-reported rates of 55.6%. It has been well documented that psychological distress such as depression may go unrecognized because of the lack of psychological symptoms [43]. This suggests that some participants might have overlooked their mental health issues. Notably, our study was conducted when the local COVID-19 outbreaks were well-managed, and as a result, more than two-thirds (69.9%) of our study participants no longer worked in the frontline COVID-19 settings. Despite this, our findings indicate that the psychological impact of COVID-19 on frontline HCWs may persist beyond their deployment period. Our results also highlight the need for comprehensive support systems and resources to address HCWs’ mental well-being during and after their COVID-19 deployment. As suggested elsewhere, this includes implementing mental health screening programs, offering psychological support services, and prioritizing the well-being of HCWs through ongoing monitoring and interventions [44,45,46]. Given the possibility of future large-scale health crises like the COVID-19 pandemic, health authorities should also make this program accompany HCWs as early as the beginning of the health crises. This helps preserve good mental health and emotional well-being of HCWs which subsequently secure the quality and capacity of their work performance.

Our findings also revealed a concerning prevalence of overall moderate-to-severe psychological distress with a rate of 36.8%. Specifically, the prevalence of moderate-to-severe depression, anxiety, and insomnia was 26.8%, 20.8%, and 23.4%, respectively. These rates were significantly higher compared to a study conducted on 661 HCWs in the comparable city of Danang, which utilized the same three mental health scales [41]. That study reported rates of 8.5% for their participants experiencing moderate-to-severe depression, 6.4% for moderate-to-severe anxiety, and 34.5% for insomnia [41]. Additionally, another study conducted in hospitals in southern Vietnam found the depression and anxiety rates of 18.0% and 11.5%, respectively [47]. This study shares similarities in study settings and populations with ours. In addition, it utilized the Depression Anxiety Stress Scales (DASS- 21) that has been proven to have a good internal reliability with the PHQ- 9 and GAD- 7 scales used in our study [48, 49]. Therefore, the disparities in the prevalence of psychological distress between our study and these studies could be attributable to the timing of the studies. Our research was conducted after Vietnam experienced all four severe waves of COVID-19, whereas the previous two studies were conducted during the second wave. The increased severity and higher mortality rates observed in the third and fourth waves would have had a devastating impact on the mental health of frontline HCWs [50]. Our moderate-to-severe depression and anxiety rates are higher than that of a similar study conducted across Vietnam during the fourth surge of COVID-19, which found a rate of 17.5% (88/503, 95%CI 14.4–21.1%) for depression and 9.5% (88/503, 95%CI 7.3–12.4%) for anxiety [51]. This is probably due to the difference in the nature of study participants. This study was conducted on all HCWs including those who did work in the frontline settings [51], while our study exclusively focused on frontline HCWs. It has been well documented that HCWs working on the frontline settings during the COVID-19 pandemic experienced more psychological health issues compared to those working in other settings [52] In light of this, our findings suggest that the severity and impact of each wave of the pandemic can influence the long-term mental health outcomes of frontline HCWs. Understanding these dynamics is crucial for developing targeted interventions and support strategies that address the specific challenges faced by frontline HCWs during different phases of the pandemic.

Although several studies have examined predictors of immediate mental health impact of COVID-19 on frontline HCWs, little is known about predictors of long-term mental health impact. Our study filled out this knowledge gap by exploring factors associated with long-term psychological distress. Our findings revealed that pre-existing physical health conditions before being deployed to respond to COVID-19 were a significant risk factor for moderate-to-severe depression and insomnia, which aligns with the results of a previous study [47]. This suggests that pre-existing physical health conditions may contribute to the vulnerability of HCWs in developing these mental health issues during and after deployment. Furthermore, our study identified that having mental health conditions prior to the COVID-19 deployment was also a risk factor for long-term psychological distress. Previous research has established that pre-existing mental health conditions, such as stress, can increase the likelihood of subsequent medical conditions, including incident psychological distress [53, 54]. Similarly, during the 2nd wave of COVID-19 in Vietnam, being anxious and stressed about current work situations was identified as a risk factor for immediate psychological distress among frontline HCWs [41]. These findings underscore the importance of considering pre-existing mental health conditions and providing adequate support to HCWs who may already be vulnerable to experiencing mental health challenges. We found no association between having COVID-19 disease experience and risks for developing moderate-to-severe psychological disorders including depression, anxiety, and insomnia. This is probably because our research was conducted after all four severe waves of COVID-19 occurred in Vietnam. Almost all participants were similarly documented to experience COVID-19 by either currently having or previously acquiring the disease or having a family member, friend or colleague currently having or previously acquiring the disease at the time the study was conducted. However, we found that being deployed to respond to the 3rd and 4th waves of COVID-19 served as risk factors for long-term depression. Compared to the first two waves of COVID-19, the 3rd wave witnessed a sharp increase in the number of infected patients, and the 4th wave was the most complex and dangerous with most deaths recorded in Vietnam [50]. A similar study conducted on HCWs including those who did work in the frontline settings during the fourth surge of COVID-19 in Vietnam found that nurses and midwives had a lower risk of developing moderate-to-severe depression and anxiety, compared to physicians [51]. However, we found no differences between frontline HCWs with different job titles and risks for psychological disorder development. Our finding reflects the unique psychological disorder risk of frontline HCWs, regardless of their job title.

We found that COVID-19 deployment at field hospitals was a predictor for insomnia among frontline HCWs. To respond to the increased number of patients during the severe outbreaks of COVID-19, various non-medical facilities including schools, universities, colleges, dormitories and apartment buildings were requisitioned as field hospitals alongside the main designated COVID-19 hospitals [55, 56]. Working in these field hospitals represented several challenges to HCWs’ sleep patterns, including reduced available sleep time, inconsistent sleep schedule, and inadequate conditions for proper sleep such as a lack of a dark and quiet environment. These factors likely contributed to the development of chronic insomnia among HCWs [57, 58]. Moreover, our study highlighted the complex and intertwined association between insomnia and the concurrent mental health including anxiety and depression [59]. These mental health factors may further exacerbate sleep disturbances and contribute to the persistence of insomnia symptoms. As of the time of developing this manuscript, local COVID-19 outbreaks have been effectively controlled, and all field hospitals have been closed in Vietnam [55]. It has been recommended that a comprehensive mental health screening program for frontline HCWs should be continued after the pandemic to enable timely mental health support [60]. In light of our findings, this screening program should specifically target HCWs who already had mental and physical health conditions before the deployment, those deployed during the 3rd and 4th COVID-19 waves, and those who worked at field hospitals. Identifying and providing timely support to these at-risk individuals can help mitigate the long-term impact of their COVID-19 deployment on mental health.

Our study has some limitations. First, study participants were asked to self-rate their previous mental well-being which may lead to recall bias. Second, study participants were deployed to respond to the most severe waves of COVID-19 in southern Vietnam. Therefore, the generalizability of our findings to other contexts with different severity levels of COVID-19 outbreaks may be limited. Third, the study specifically examined depression, anxiety, and insomnia in frontline HCWs. While these are important psychological distress, we acknowledge that other relevant mental health conditions might have been overlooked. Future studies could explore a broader range of psychological distress to capture the full spectrum of mental health challenges faced by HCWs in the aftermath of COVID-19 deployment. Another limitation is the timing of our study, which was conducted seven months after Vietnam entered the “new normal” phase. The long-term implications of COVID-19 deployment on HCWs’ mental health might continue to evolve over time [61]. Therefore, longer follow-up studies are needed to better quantify the burden of long-term psychological distress among frontline HCWs.

Conclusion

Our study highlights the substantial impact of COVID-19 deployment on HCWs’ long-term mental well-being. The prevalence of moderate-to-severe psychological distress, including depression, anxiety, and insomnia, was particularly concerning. The psychological impact of COVID-19 on HCWs proportionally increases with the severity of the COVID-19 outbreaks that they were involved in and is prolonged, even after their deployment. Nationwide studies with longer follow-ups are needed to fully explore the magnitude of psychological distress among all HCWs who were deployed to respond to the COVID-19 outbreaks across Vietnam. As HCWs may overlook their mental health issues, a screening program with psychological support services is needed as early as the beginning of the future pandemics.

Data availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Abbreviations

aOR:

Adjusted odds ratio

DASS:

Depression Anxiety Stress Scales

GAD- 7:

Generalized Anxiety Disorder 7-item scale

HCWs:

Frontline healthcare workers

ISI:

Insomnia Severity Index

PHQ- 9:

Patient Health Questionnaire with 9 items

SPSS:

Statistical Package for Social Sciences

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Acknowledgements

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Funding

This work was supported by the Australian Government through the Australian Alumni Grants Fund [grant number AAGF-R4-00090] to Minh Cuong Duong.

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Authors and Affiliations

  1. Faculty of Nursing, Phenikaa University, Hanoi, Vietnam

    Hong Trang Nguyen & Ba Tam Nguyen

  2. Department of Infectious Diseases, FV Hospital, Ho Chi Minh City, Vietnam

    Bich Thuy Duong

  3. Adult Intensive Care Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam

    Bich Thuy Duong

  4. Center for Innovation in Mental Health, Graduate School of Public Health & Health Policy, The City University of New York, New York, USA

    Thinh Toan Vu

  5. Department of Community Health & Social Sciences, Graduate School of Public Health & Health Policy, The City University of New York, New York, USA

    Thinh Toan Vu

  6. School of Health Sciences, University of New South Wales, Sydney, NSW, Australia

    Sophia Lin

  7. Department of Microbiology, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia

    Tri Nugraha Susilawati

  8. School of Population Health, University of New South Wales, Samuels Building, F25, Samuel Terry Ave, Kensington, Sydney, NSW, 2033, Australia

    Minh Cuong Duong

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Contributions

CMD, BTD, and HTN designed the study. MCD, BTD, BTN, and HTN performed data collection. MCD, BTD and HTN performed statistical analysis. MCD, BTD, HTN, BTN, TTV, SL and TNS interpreted the results. MCD, BTD and HTN drafted the manuscript. All authors revised the paper critically for important intellectual content. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Minh Cuong Duong.

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Ethics approval and consent to participate

This study was conducted in accordance with the guidelines outlined in the Declaration of Helsinki. In addition, the study was approved by Ethics Committees of Nam Dinh University of Nursing (approval number 1270/GCN-HĐĐĐ) and HTD (approval number 2519/QĐ-BVBNĐ). Written informed consent was obtained from all study participants.

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The authors declare no competing interests.

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Nguyen, H.T., Duong, B.T., Vu, T.T. et al. Exploring the magnitude and predictors of the long-term psychological impact of COVID-19 on frontline healthcare workers in Vietnam: a multi-center, cross-sectional study. BMC Health Serv Res 25, 553 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12913-025-12702-z

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BMC Health Services Research

ISSN: 1472-6963

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