Evaluating the psychological impacts related to COVID-19 of healthcare workers and some associated factors in Hanoi in 2020

Related factors with mental health problems of healthcare workers.... Association between mental health problems and healthcare workers' fear of SAR-CoV-2 infection...40Table 3.23.. Besi

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First and foremost I would like to acknowledge to my thesis Assoc Prof Le Thi Thanh Xuan who had directly guided and created necessaryconditions for me to participate in Illis research With her dedication, patience,intellectual guidance I had a precious opportunity to learn more about academicskills along with accomplishing my final thesis

advisor-My journey along with this research allowed me to come in contact withmedical managers and healthcare workers Their thorough, objective renewscontributed immeasurably in the desired outcome of this work

My sincere appreciation also goes to the health workers in range ofdepartments in Hanoi’s health care facilities, for participating and providing datafor the research

The successful navigation through the university met various obstacles thatwould not have been suipassed without the guidance from all lecturers of HanoiMedical University; particularly lectureis from School of Preventive Medicineand Public HealtíL

Last but not least, mam' thanks were given to my family and friends whoencourage me throughout the period of difficulties

Hanoi 25* May 2021Tran Thỉ Thuy Lỉnh

Respectfully addressed to:

Department of Under- Graduation Training Hanoi Medical University

- Department of Occupational Health School of Preventive Medicine and Public Health

- Board of Dissertation Assessment

I guarantee that this study is my scientific research which I carried out asone of the main investigators The- results and figures in this research collectedare accurate and have not been published and reported in any other publications

I will be responsible for any delusion detected

Hanoi 25* May 2021The AuthorTran Thí Thuy Linh

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INTRODUCTION.— - 1

Chapter 1: LITERATURE REMEW 3

1.1 Basic concepts 3

1.1.1 Definition of mental health and health workers 3

1.1.2 Definition of history ofCOVID-19 and situation 4

1.2 Ps ychological changes of healthcare workers 11

1.3 Related factors with mental health problems of healthcare workers 13

Chapter 2: METHODOLOGY - — — 15

2.1 Study duration and location 15

2.2 Study population 15

2.3 Study design 15

2.4 Sample size and sampling method 16

2.5 Study variables and indicators 17

2.6 Data collection tool and method 17

2.7 Data management and analysis IS 2.8 Bias and control 19

2.9 Ethical considerations 19

Chapter 3: RESULTS - 21

3.1 Demographic characteristics of respondents 21

3.2 The mental health problem of respondents during the C0V1D-19 pandemic 24 3.3 Some factors associated with mental health problems of respondents 29

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4.1 Demographic characteristics of respondents 45

4.2 The mental health problem of respondents during the COVID-19 pandemic in Hanoi in 2020 47

4.3 Association between mental health problem and related factors 49

CONCLUSION 55

RECOMMENDATION 56 REFERENCES

APPENDIX 1

APPENDIX 2

ARDS Acute Respiratory Distress Syndrome

IES-R Impact of Event Scale - Revised

ILO International Labor Organization

MERS-CoV Middle East Coronavirus Respiratory

Syndrome

SARS-CoV-2 Corona\irus-2 Acute Respiratory Syndrome

PTSD Post Traumatic Stress Disorder

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Table 3.1 Personal characteristics of respondents 21

Table 3.2 Occupational characteristics of respondents 22

Table 3.3 Mental health problems among study- participants through IES-R score 24 Table 3.4 Level of mental health problem through gender 25

Table 3.5 Level of mental health problem through age groups 26

Table 3.6 Level of mental health problem through working department 27

Table 3.7 Level of mental health problem through job ty pes 28

Table 3.8 Level of mental health problem dirough length of work experience 29 Table 3.9 Association between mental health problems and age group 29

Table 3.10 Association between mental health problems and gender 30

Table 3.11 Association between mental health problems and education levels 31 Table 3.12 Association between mental health problems and marital status 31 Table 3.13 Association between mental health problems and person liũng with 32 Table 3.14 Association between mental health problems and level of hospital 33 Table 3.15 Association between mental health problems and job types 34

Table 3.16 Association between mental health problems and department 35

Table 3.17 Association between mental health problems and length of work experience 36

Table 3.18 Association between mental health problems and perception on the exposure risk to COVTD-19 through breathing air among respondents 37

Table 3.19 Association between mental health problems and perception on the exposure risk to COVID-19 through colleague 38

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Table 3.21 Association between mental health problems and perception at

high risk to COVID-19 40Table 3.22 Association between mental health problems and healthcare

workers' fear of SAR-CoV-2 infection 40Table 3.23 Association between menial health problems and and health care

workers' fear of SAR-CoV-2 infection by family members 41Table 3.24 Association between menial health problems and fear about poor

survival if infected with SAJRS-CoV-2 42Table 3.25 Association among mental health problems and perception on the

exposure risk to COVID-19 among respondents 43

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Figure 1.1 The structure of coronavirus causes acute respiratory syndrome inhumans 5Figure 1.2 History of coronavirus naming during the three zoonotic outbreaks in

relation to virus taxonomy and diseases caused by these virusesóFigure 1.3 Tile main hosts and the method of infusion of Coronavirus

(suspected hosts SARS-Co V-2 are surrounded in red) 9Figure 3.1 The percentage of education level of respondents 22Figure 3.2 The percentage of departments of respondents 24

Reasonale : The COVID-19 pandemic has affected the economy, politics ingeneral, and people worldwide The global problem is how to cure patients withCOVID-19 and keep the disease under control This issue is not only achallenging and urgent problem for the state, senior officials, and even thepeople Besides, few people concerned about healthcare workers' mental health -the frontline force of disease prevention and treatment.

Problem: The study aimed to determine tire mental health issues ofhealthcare workers in Vietnam during the COVID-19 pandemic because thisissue lias not been paid much attention in Vietnam Meanwhile there are a lot ofresearch on this issue in tire health force around the world I hope that this studywill help policy makers have a timely solution to discover and support by theirmedical staff and medical managers

Methods: We conducted n = 2157 healthcare workers in Hanoi through anonline survey using snowball sampling technique

Results: The degree of symptoms of depression anxiety, insomnia, anddistress was assessed by the 22-item Impact of Event Scale-Revised Threecrucial factors related to the mental health of healthcare workers found in tirestudy are fear of infection, fear of infecting to family members, and fear ofsuffering the disease This problem drew the lesson that not only citizents butalso healthcare workers have concerns about COVID-19 in general

Conclusion: Our findings observed healthcare workers faced with mentalhealth problems and therefore, theyare also needed support from the authorities,medical managers, and families in terns of mental health

Key words : The COVID-19 pandemic, healthcare workers, mental health

2. The human coronavirus discovered in 2003 SARS-CoV which causes severeacute respiratory syndrome (SARS) lias a unique pathogenesis because it causesboth upper and lower respiratory' tract infections It is estimated that in the early’stages, the mortality rate of epidemics worldwide is estimated to be about 2%.with the majority of deaths occuning in special populations such as backgroundpathology, weakened immune system and the elderly people ’ In the face of thecomplexity of the epidemic, on March 11 2020 WHO officially declared theoutbreak of acute respiratory infections caused by the new sttain of the Coronavirus as a “Global Pan-Epidemic" 5 and as of mid-April 2020 more Ilian 200countries have recorded epidemics with the total number of cases having reachedmillions and hundreds of thousands of deaths6 As of 20 April 2021 there havebeen at least 3 032 124 confirmed deaths and more than 142 238 073 confirmedcases in the COVID- 19 pandemic and occuring in all countries in die world6.

COVID-19 raises an increasing amount of information and concerns areimpacting on global mental health Global media, local and international healthorganizations (including World Health Organization), epidemiologists,virologists and opinion-makers put out information, recommendations andminute-by-minute updates on COVID-19 spreading and lethality Nevertheless,the burden of this infection on the global mental health is currently neglectedeven if it may challenge patients, general population, as well as policy makersand health care workers

Although there have been many- studies on mental health during theCOVID-19 epidemic, most are concentrated in countries with large outbreaks

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such as the Brazil UK China '9 In Vietnam on May 19 2021 there were 4.543cases of COVID-19; 37 deaths and 2.687 recovery cases Hanoi Da Nang,Quang Nam and Ho C1Ú Minh City are the provinces with the highest number

of COVID-19 cases in Vietnam Thus, we conducted research “Evaluating thepsychological impacts related to COVTD-19 of healthcare workers andassociated factors in Hanoi 2020" with two following objectives:

7 To describe the psychological impacts of healthcare workers during the cot

1D-19 pandemic in Hanoi, 2020

2 To (f escribe some relative factors with the psychological impacts of healthcare workers in Hanoi, 2020

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Chapter 1LITERATURE REMEXV

I 1 Basic concepts

J 1.1 Definition of mental health and health workers

According to die World Health Organization's 1978 Declaration at AlinaAta: "Health is a state of complete comfort both physically, mentally and sociallyrather than just without disease or disability" Comprehensive health in every'human being consists of three components: physical health, mental health andsocial health 10

As defined by the Vietnam Psychiatric Society: “Mental health is a state ofnot only no mental disorders or malformations but also a completely relaxedmental state; to have a relaxed mental state that needs to have a good quality' ofliving, to have a balance and harmony between individuals, people around andthe social envứonment” 1!-

Healthcare human resources - adso known as healthcare workforce orhealth care workers - are defined as "all those involved in actions with theprimary' purpose of improving health", according to the World HealthOrganization's 2006 report i: Medical human resources are identified as one ofthe maul pillars of a health system They include doctors, nurses, midwifes,dentists, pharmacists, others working in the health sector Other healthcareworkers may include community health workers, social health workers and otherhealth care providers as well as health support and management workeis Thosewho do not provide direct medical services, but essential for the health system tofunction effectively such as health senice managers, medical record; and healthinformation technicians, health economists, health supply chain managers,medical clerks and others

1.1.2 Definition oflùstoryofCOỈlD-19 and situation

1.1.2.1 Definition of Coronavirus

The name “Coronavirus*' is derived from the Latin corona, which means

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crown or aura, and refers to the characteristic appearance of the virion under anelectronic microscope with a large fringe, which forms an image such as a royalcrown or corona 13

Coronavirus (also known as corona virus) is a group of viruses of the subfamily Coronavirinae in the family Coronaviridae according to the OrderNidovirales Coronavirus causes disease in mammals, including humans andbirds u

Corona virus was detected in the 1960s '•• The first people found to beinfected with the infectious bronchitis virus in chickens and two viruses from thenasal cavity of patients with the common cold were named human coronavirus229E and human coronavirus OC43 :6 In humans, the virus that causesrespiratory infections is usually mild but rare cases can be fatal1?

There are seven strains of human coronavirus that have been known:

1 Human coronavirus 229E (HCOV-229E)18

2 Virus coronavirus OC43 (HCoV-OC43)19

3 SARS-CoV (2OO3)20

4 Human coronavirus NL63 (HCOV-NL63 coronavirus New Haven)(2004)20

5 Human coronavirus HKƯ1 (2005) *'■

6 Middle East respiratory syndrome-related coronavirus (MERS-CoV) CoV 20

0-7 SARS-CoV-2 (2019) 20

In animals, coronavirus also causes a wide range of diseases in farmanimals and domesticated livestock, some of which can be serious and pose athreat to the agricultural sector 2: In chickens, the Infectious Bronchitis Virus

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(IBV) a type of coronavirus is aimed not only at the respirator.’ tract, but alsothe urinary tract The virus can spread to various bodies throughout the chickenbody Important economic coronaviruses of farm animals include coronaviruspigs (infectious gastroenteritis coronavirus TGE) and cow coronavirus, whichboth result in diarriiea in young cattle23

1.1.2.2 Definition of virus SARS-Col -2

Severe acute respirator}.' syndrome corona virus 2 formerly known as thenew corona virus 2019 (2019-nCoV) is a coronavirus strain tliat causes acuterespiratory infections caused by corona virus 2019 (COVID-19)20

Figure 1.1 The structure of coronavirus causes acute respiratory syndrome in

lirimans

On January- 12 2020 it was named 2019-nCoV by the World HealthOrganization, based on a method of naming the new corona virus 24 On 11February 2020 the International Commission on Virus Classification (ICTV)decided to officially name this new strain of corona virus SARS-CoV-2 whenthey analyzed that it was the same species as the SARS virus that caused the

2003 epidemic but is another strain of the species 2J Although relevant, these twoviruses are different WHO announced "COVID-19" as the name of tire newdisease on 11 February 2020 following previously developed guidelines with theWorld Organization for Animal Health (OIE) and the Food and AgricultureOrganization of the United Nations (FAO)24

1 Severe acute

Coronaviru s

This newly discovered coronavirus has a genome similar to the virus that caused the 2003 SARS epidemic (SARS-CoV) by more than 70%31 The

SARS-CoV-2 virus spread faster than its two ancestors SARS-CoV-1 and

MERS-CoV but had a lower mortality’ rate3:

1.1.2.3 Pathological features and origin ofCOỈ7D-19

COVID-19 is an acute respiratory disease caused by a novel emergedcoronavirus- SARS-CoV-2 33 In 2003 China's population was infected with avirus that causes Severe Acute Respiratory Syndrome (SARS) in GuangdongProvince 34 Tile virus lias been confirmed as a member of the Betacoronavirussubgroup and has been named SARS-CoV-1 Infected patients present withpneumonia symptoms with di fluse alveoveic lesions leading to acute respiratorydistress syndrome (ARDS) 3i SARS initially appeared in Guangdong China andthen spread rapidly globally with over 8000 infected people and 776 deaths ?i Adecade later in 2012 several Saudi nationals were diagnosed with another type ofcoronavirus3? The virus was found to have been confirmed as a member of thecoronavirus and was named Middle East Coronavirus Respiratory Syndrome(MERS-CoV) • The World Health Organization reports that MERS-CoV liasinfected more tfian 2428 individuals and 838 deaths 3S MERS-CoV is a group ofbeta-coronavirus members and is diverse in genotypes from other Co-hunians 39

MERS-CoV infection begins witfl a mild upper respiratory injury whileprogression leads to serious respiratory disease 35 Similar to SARS-CoV-1

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new type of coronavirus Moreover, genetic order is also provided for thediagnosis of viral infections The virus with single-threaded RNA namedCoronavirus-2 Acute Respiratory Syndrome (SARS-CoV-2), has been isolatedfrom a patient with pneumonia and connected to a group of cases of acuterespiratory’ disease from Wuhan COVID-19 is the third known coronavirusafter SARS and Middle East Respiratory Syndrome (MERS) SARS-CoV-1 andMERS-CoV are also in tile group - coronavirus i- Genetic analysis has revealedthat it is closely related to SARS-CoV-1 and genetic clusters in the genusBetacoronavirus, the Sarbecovirus sub-gene4S

Initially, it was suggested that patients infected with coronaviruspneumonia in Wuhan in China may have visited the seafood market where liveanimals were sold or could use infected animals or birds as food sources.According to current data, the first 5 cases of COVID-19 are related to the SouthChina Sea seafood market and cannot exclude the possibility of human- to-human transmission The WHO report suggests that SARS-CoV-2 can bedetected in environmental samples collected from the aquatic market, but has notyet been determined if a particular animal carries SARS-CoV-2 A study by Ji et

al has shown that SARS-CoV-2 is a virus between a bat that carries coronavirusand a coronavirus of unknown origin By comparison with other animals, theyfound that snakes were the most likely wildlife for SARS-CoV-

2 Benvenuto et al’s research shows that SARS-CoV-2 was closely related only

to coronavirus isolated from bats in China in 2015 Their research supports thetheory’ that transmission sequences start from bats to person Chan et al and Hui

et al have confirmed that SARS-CoV-2 is a new type of coronavirus closelyrelated to SARS-CoV-2 bats Recently Zhou et al and Wu et al discovered asimilar equation between SARS-CoV-2 and SARS- CoV-1 of 79.5% They alsofound that SARS-CoV-2 is highly similar to

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coronavirus bats Therefore, currait evidence strongly supports that SARS-

CoV-2 is derived from bats, although the intermediate hosts of SARS-CoV-CoV-2 are stillidentified

However, further investigations show that some individuals are infectedeven without a record of visiting the seafood market These observations showedthe virus’s ability to spread from person to person, which lias since been reported

in more than 100 countlies around the world The human-to- human spread of thevirus occurs due to close contact with an infected person, contact with coughing,sneezing, respiratory drops or aerosols These aerosols can enter the human body(lungs) through the respiratory ttact through the nose or mouth

IMWAC# 0» c o

B<fc<orocavi7ut Unsafe A

surrounded in red)

Only « and 3 coronaviruses arc capable of infecting humans, theconsumption of infected animals as a food source is the main cause of theanimal's transmission of the vims to humans and due to close contact with aninfected person, the virus continues to spread to healthy people The dotted blackarrow shows the ability to transmit viruses from tire bat while the characteristicblack arrow represents the transfer

The origin and transmission are importantly identified to develop

M M

?

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preventive strategies to prevent infection In the SARS-CoV-1 case, theresearchers initially focused on panda dogs and civet dogs as a primary ofinfection However, only isolated samples from civets in the food market showedpositive results when viral RNA was detected, suggests dial civets may be asecond host In 2001 samples isolated from healthy Hong Kong people andmolecular evaluation showed 2.5% anti-body anti-SARS- coronavirus rate.These signs show that SARS-CoV-1 may have circulated in humans beforecausing the outbreak in 2003 Subsequently, the rhino bat was also found to haveanti-SARS-CoV-I antibodies indicating that the bat was a source of viralreplication Coronavirus syndrome in the Middle East (MERS) first appeared in

2012 in Saudi Arabia MERS-CoV is also associated with beta-coronavirus andhas camels as the primary source of animals or hosts In a recent study MERS-CoV was also detected on the bats PipistTellus and Perimyotis, claiming that batsare the main host and means of transmission of diseases of the virus "5 Initially,

a team of researchers suggested that snakes were possible hosts, however, afterdiscovering file genome similarity of the new coronavirus to the S.ARS- like batvirus supported the claim tlrat not snakes but only bats were the main reservoirs.Further analysis of similar recombining shows that glycoprotein is associatedwith receptors of newly developed coronaviruses from SARS-CoV-1(CoVZXC21 or COVZC45) and Beta-CoV not yet known However, in order toeradicate the virus, more work needs to be done in the aspects of determining theinterrmdiate source of animals that cause the transmission of the virus to humans

All coronaviruses contain specific genes in the region below ORF1 thatencode proteins to replicate viruses, nucleocapsids and form spines '6.Glycoprotein spines on the outer surface of the coronavirus are responsible forthe attachment and penetration of the virus into host cells (Figure 1.1)

Domain-linked receptors (RBDs) are loosely attached between viruses soviruses can infect multiple hosts Other coronaviruses primarily recognizeaminopeptidase or caibohvdrates as an important cell to enter human cells while

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SARS-CoV-1 and NlERS-CoV recognize exopeptidase The mechanism ofpenetration of coronaviruses depends on the protease of cells including trypsin-like protease in the human airways (HAT), cathepsins and serine protease 2(TMPRSS2) that separate the spiked protein and produce further penetrationchanges MERS-CoV uses dipeptidyl peptidase 4 (DPP4) while HC0V-NLÓ3and SARS-CoV-1 require the enzyme to convert angiotensin 2 (ACE2) as themain receptors

1.2 Psychological changes of healthcare workers

In the fight against the COVID-19 epidemic, healthcare workers in Wuhanhad faced enormous pressure, including high risk of infection and insufficientpersonal protective equipment, over-work, frustration, discrimination isolationpatients with negative emotions, lack of contact with their families andexhaustion Serious conditions are causing mental health problems such as stress,anxiety, depressive symptoms, insomnia, anger and fear These mental healthissues not only affect medical workers's attention and understanding but also todecision-making abilities This could hinder the fight against COVID-19 Inaddition, the COVID-19 epidemic lias a longterm impact on overall health aswell as affecting the quality of life and work of healthcare workers4"

COVID-19 lias a significant impact on public health and poses challengesfor healthcare workers, especially frontline medical workers that come into directcontact with patients with COVID-19 There have been a number of studiestalking about the impact of the COX1D-19 epidemic on the health, life and work

of healthcare workers in particular and people in general Studies around tileworld show that the COVID-19 epidemic can affect the

mental health of healthcare workers by increasntg COVID-19 infection rates andincreasing the incidence of insomnia, fatigue, anxiety depression or suffering formedical workers 1 ■50 A previous study revealed that the imposition of lockdown

in China put more than 50 million people under quarantine to prevent theinfection, leading to a "desperate plea" for support 51 More than half of the

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participants rated the pandemic’s psychological impact as moderate or severe,and about one-third of them reported moderate to severe anxiety symptomsResearch studies from Iran and Japan also highlighted the seriousness of theCOVID-19 misinformation, social isolation resulting in mental health problems,and a liigh level of panic behavior, such as stockpiling of resources in thepopulation 5“ ?s.The severe acute respiratory syndrome (SARS) epidemic in 2003was positively related to a high level of anxiety among recovered patients and therisk of suffering from post-traumatic stress disorder among those who survivedlife-threatening condition }5 In the H1N1 influenza outbreak, the general publicalso revealed fears about tire probability of contracting the vims " Lessonslearned from previous epidemics show that assessment and interventions play acritical role in mitigating the psychological issues, especially among healthcareworkers56

Because of COVID-19 Vietnam, a developing country, was on higheralert due to its land bord?r with China and overseas travel between two countriesrelated to business and tourism The government of Vietnam imposed “socialdistancing and social isolation" at the beginning of April 2020 to mitigate thespread of COVID-19 with prompt contact tracing and quarantine ? Socialdistancing, or "physical distancing" means that one person keeps a safe space(about 2 anus' length) from other people who are not from their household inboth indoor and outdoor spaces For the first time in Vietnam, people haveundergone "social distancing" to minimize infectious disease transmission.Although, these deliberate preemptive strategies bring positive effects onslowing down of positive tests, abiding by social distancing may ramp upprofound impacts on the mental health of medical workforce and local citizens -s.Healthcare workers forced to live temporarily in the healthcare center to treat forpatients and isolate with their family Emotional distress stressors includefinancial losses, the fear of COVTD-19 infection, and severe shortages ofpersonal protective equipment 59' 60 Previous studies suggested that people with

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different social-economic backgrounds and history'risk of exposure to theCOV1D-19 experienced a different severin' level of mental health problems 51,61 -

62

13 Related factors with mental health problems of healthcare workers

The previous study used 37 full-text articles during July 2020 usingGoogle scholar PubMed as databases to critically evaluate the related factorsthat demonstrated an influence on psychological and mental health during theCOVID-19 pandemic over tire world 65 In Taiwan COVID-19 pandemic causedsleep disturbances and suicidal thoughts in healthcare workers In China, theSARS-CoV-2 epidemic brought high levels of psychological distress, insomnia,alcohol, aid drug misuse, and symptoms of post-traumatic stress disorder(PTSD), depression, and higher perceived stress primarily on medical staff andall healthcare and emergency workers, which seem to be tire most affectedcategories 6M" Huang and Zhao (2020) observed higher levels of stress related tohow often people think about the epidemic 6i Concerning suicide cases, in Indiathe results of the qualitative analysis enlighten underlying reasons, such as fear

of COVTD-19 infection financial crisis, loneliness, social boycott, pressure forquarantine, fear of positive COVID- 19 and pre- and post- lockdown work-related stress 6S

As COVID-19 made its way to Vietnam, healthcare workers faceduncertainty in all aspects of their lives, including their work environment,financial stability, job stability, and their home environment 69 During the

"social distancing" time, at the individual level, mass home-confinementdirectives (quarantine or self-isolation) are associated with numerous adverseemotional outcomes such as depression, boredom, irritability, and stigma related

to quarantine s Healthcare systems were not prepared to deal with the pandemicand healthcare workers have dealt with sltortages of recommended suppliesincluding gowns, masks, face shields, and respirators, which paid massivepressure on individual medical worker s- 6: As the number of cases increased

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and nonessential senices in hospitals were stopped, healthcare systems acrossViet Nam redeployed some healthcare workers and furloughed many Privatepractices also were affected, reducing staff as patient volumes fell and clinicvisits were replaced with telemedicine One area of primary concent to mostfrontline workers is tire safety of their families Healthcare workers limitphysical contact with family members, wear protective equipment at home, orisolate at home Some chose to live away from their families to minimize the risk

of viral transmission

In addition, the consequence of the loss of meaningful connections,confronting a pervasive impairment of society and difficult}’ in ensuring safemedical care for all patients within huge workload can increase the risk ofpsychiatric illness attributed to COVID-19 ’■5

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Chapter 2METHODOLOGY

2.1 Study duration and location

- Duration: The study was conducted from April 2020 to April 2021 Thedata was collected in April 2020 (in two weeks during the 1 ” national lock down

in Vietnam)

- Location: Survey online - survey of medical staff, research was conducted

at medical facilities COVID-19 tteatment facilities and disease control center(CDC) in Ha Noi city

• Healthcare workers (pharmacist, ambulance driver, receptionist,administrative staff ) who directly participated in COVID-19 epidemicprevention at centers for disease control (CDC) Hanoi

• Had a working duration of at least 6 months or more at the study time

• Agreed to participate in the study

Exclusion criteria:

• Healthcare workers was absent during the study period

• Healthcare workers was a person infected with COVID-19

2.3 Study design

A cross-sectional study

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2.4 Sample size and sampling method

> Sample size for quantitative research (survey online)

Apply the sample size formula for estimating a population proportion with specified absolute precision:

Of which:

n: minimum sample size

Zj „2- the corresponding value of the confidence limit factor with a

confidence level of 95% is 1.96

p = 0.091 (Post-traumatic stress disorder (PTSD) rate of medical workers in

31 provinces in China in Song X and partners) '

d: absolute precision of p d = 0.02

Thus, sample size was n = 794 Ill fact, we recruited 2157 health workers inthe study

Sampling: Snowball sampling technique was applied to recruit participants

At the beginning of the recruitment process, a core group of Hanoi MedicalUniversity was set up

The core group had a higher probability of knowing other people throughmedical students (fornw and curent) and staff at different medical Universities inVietnam We selected groups to reflect the diversity of study subjects, includingage gender, and occupation throughout the country By sending the link to accessthe questionnaire from their deskstop or laptop for survey participation the coregroup able to access to their closed contacts or different groups by social network(facebook zalo) The contact persons who had been involved in the study wereinstructed to invite other Vietnamese people to join in the survey Studyparticipants included healthcare workers in hospitals, health care centers, medicaluniversities staff throughout healthcare

centers in Hanoi A total of 2157 participants (hospital staffs, university medicalstaffs) were selected for the sample during two weeks of data collection

n

22-to the following calculation formula:

Total score = QI + Q2+ + Q2I + Q22

- Risk of exposure: perception of risk of exposure to COVID-19 through airbreath, colleagues exposed to COVID-19 patients and current job; fear of SAR-COV-2 infection bv family members and low survival

2.6 Data collection tool and method

- A self- administered questionnaire consisting of 44 questions in forms ofsingle-choice, multiple-choice, and open-ended questions pertaining to the effects

of the COVID-19 pandemic on personal life and work of healthcare staff was sent

to the respondents The questionnaire was developed according to the one used forassessing life and job impacts due to SARS pandemic

- Demographic characteristics: we included questions to measure

sociodeinographic characteristics including age goups gender (male/female).marital status (single/separated/uindowedmaiTied), living status, educational level

- Information regarding the impact of COVID-19: The response was

recorded in five-point Likert scale (l=sưongly disagree: 5= strongly agree) withscore of 1 to 2 taken as negative response, and 3 to 5 as positive response Thescores obtained for intmsive-avoidance items in the IES revised was analysed as

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"high” or "low" scores, equivalent with "yes” or “no" suffering the mental healthproblems and the 24 score was used as cutt-off point76

2.7 Data management and analysis

Quantitative data were entered and cleaned using Epidata 3 L software andanalyzed using ST ATA 14.0 software

• Descriptive statistics are used to calculate frequency and percentage ofeach variable, thereby assessing the mental health of the COVTD-19 pandemic onmedical workers

• Inference statistics by statistical tests for the qualitative variable is using asingle or multivariate logistic regression model to determine the effects ofCOVTD-19 on mental health of medical workers on dependent and indepentvariables Select variables into multivariate regression by using single logisticregression on STATA 14.0 and then multivariate regression analysis withsignificant univariate regression variables Independent variable was demographiccharacteristics, occupational characteristics and risk of exposure Dependentvariables were the 22-item Impact of Event Scale revised (IES-R) p-value was at0.05 level

• Impact of Event Scale revised (IES-R) was used to measure intrusive andavoidance items made by Vietnamse people dining stressfull life event such asCOVID-19

2.8 Bias and control

• Bias

-Bias recall

- Bias related to designing data collection tools

- Unclear questionnaire items and illogical move from one question item toanother

- Bias due to participants* misunderstanding the item content

• Bias control

-Reviewing all the tools before implementing the data collection and

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-The interviewers have the responsibility for giving the intervieweesclearified explanation of the question items in the case they do not understand theitem content

-Checking and re-checking data Regarding to the missing information, itmust be immediately filled out either directly at the surveying settings or indirectlythrough tíie phone line and e-mail

- Double data entering for cross checking, any mistake identified would bechecked directly with information written in the questionnaire and being corrected.2.9 Ethical considerations

• Subjects are fully informed of the purpose as well as relevant informationabout the research and agree to voluntarily participate in the study

• Research does not affect the health and other benefits of research subjects

• Research is committed to the confidentiality of personal information abouttire subject of research is guaranteed to keep absolute confidentiality

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The results of the study are used only for scientific research purposes, protecting human health for no other purpose

• The study was approved by the Scientific Council of the School of

Preventive Medicine and Public Health Hanoi Medical University in March 2020 before the official implementation

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RESULTS

3.1 Demographic characteristics of respondents

Table 3.1 Personal characteristics of respondents

Table 3.1 presents the demographic characteristics of the 2157 respondents

in the research More than half of participants were female (65.83%) In terms ofage the majority of participants was 30-39 years old

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college /university degree was the highest percentage (64.02 %) meanwhile thelowest percentage were participants having lower degree (3.25%) The majority ofstudy subjects were married (81.87%) and living with family / friends (95.32%)

EDUCATION LEVEL OF RESPONDENTS

> >H<hi<hool ■tlement^v ■ University ■ decree

Figure 3.1 The percentage of education level of respondents

Table 3.2 Occupational characteristics of respondents

Districthealth

Full-time contract within term

3.2 The mental health problem of respondents during the COVID-19 pandemic

Table 3 J .Mental liealtli problems among study participants through IES-R score

DEPARTMENTS OF RESPONDENTS

3 71

■ tnterrul rnedone : im»grng OiignoiA Sc*entrf< laboratory- Clinic

■ Adminntratrce office*

Table 3.4 Lexel of mental health problem through gender

Table 3.5 Level of mental health problem through age groups

Table 3.6 Lexel of mental health problem through working department

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ClassificationWorking

Table 3.6 shows the level of mental health problem through working department The

participants working in Infectious disease- infection controlwas less likely to suffer mental health problem (mild: 5.08% moderate: 1.67%.severe: 4.25%) The percentage of participants working in Imaging diagnosis-scientific laborator}'- clinic and Administrative offices had morderate level was1833% The Internal medicine accounted the highest percentage in severe level, with

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3.3 Some factors associated with mental health problems of respondents

Table 3.9 Association between mental health problems and age group

MENTAL HEALTH PROBLEM

p-valueAge -

NOFrequency

0/0

OR (950bCI)