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

Problem: The study aãned to determine tire mental health issues of healthcare workers in Vietnam during the COVID-19 pandemic because this issue has not been paid much attention in Vietn

First and foremost 1 would like to acknowledge to my thesis advisor*Assoc Prof Le Thi Thanh Xuan who had directly guided and created necessary conditions for me to participate in this research, with her dedication, patience, intellectual guidance I had a precious opportunity to leant more about academic skills along with accomplishira; my final thesis.

My journey along with this research allowed me to come in contact with medical managers and healthcare workers Tlteir thorough objective reviews contributed immeasurably in the desired outcome of this work

My sincere appreciation also goes to The health workers in range of departments in Hanoi's health care facilities, for participating and providing data for rhe research

Tie successful navigation through the university met various obstacles tliat would not have been surpassed without tire guidance from all lecturers of Hanoi Medical University particularly lecturers from School of Preventive Medicine and public Health

Last but not least, maty thanks were given to my family and friends who encourage me throughout the period of difficulties

Hanoi 25* May 2021Tran Thi Thuy Linii

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

1 guarantee dial this study is my scientific research which I carried out as one of tire main investigators The results and figures xn tills research collected are accurate and ha\r not been published and reported in an}- other publications

1 will be responsible for any delusion detected

Hanoi 25* May 2021The AuthorTran Thi Thuy Linh

Chapter 1: LITERATURE REVIEW

11 Basic concepts

1.1.1 Definition of mental health and health workers

1.12 Definition of history of COVID-19 and situation

1.2 Psychological chaises of heahhcare workers

3

1 I1.3 Related factors with mental health problems of healthcare workers 13Chapter 2: METHODOLOGY

2.1 Study duration and location

2.2 Study population

15 15

2.7 Data management and analysis

17 18192.9 Ethical considerations

Chapter3: RESULTS

3.1 Demographic characteristics of respondents -

19 21

4.2 The menial health problem of respondents during the COVID-19pandemic in Hanoi in 2020 474.3 Association between mental health problem and related factors 49

ARDS Acute Respiratory Distress Syndrome

MERS-CoV Middle East Coronav ins Respiratory Syndrome

SARS-CoV-2 Corona\iru$-2 Acute Respiratory Syndrome

Table 3J Personal characteristics of lepondents Table 3.2 Occupational characteristics of respondents - Table 3.3 Mental health problems amors’ study partcipants through IES-R scoreTable 3.4 Lex-el of mental health problem through gender.« Table 3.5 Lexel of mental health problem through age groups Table 3.6 Lexel of mental health problem through working department Table 3.7 Lexel of mental health problem through job ty pes Table 3.8 Lexel of mental health problem through length of woric experienceTable 3.9 .Association betxveen mental health problems and age group Table 3.10 Association between mental health problems and gender Table 3.11 Association between mental Irealth problems and education lex elsTable 3.12 Association between mental health problems and maiital status 31Table 3.13 Association between riKĩital health problems and person living with 32Table 3.14 Association betxveen mental health problems and level of hospital 33

21

24

2526->728

29

293031

22

Table 3.15 Association between mental health problems and job types 34Table 3.16 Association between mental health problems and deportment 35Table 3.17 Association between mental healUi problems and length of work

experience • •••••••••• 44 ••••••••• 4* 4»»44»« ••••••••••••• •••••••••••

Table 3.18 Association between mental health problems and perception on

the exposure risk to COMD-19 through breahing air amongrespondents aixi (•■•■MUMialMa *4 4 4A •*<••• 44 4 »4 4 4*4 •••• 37Table 3.19 Association beĩxvren mental health problems and perception on

lire exposure risk to COX1D-19 through colleague 38Table 3.20 Association between mental health problems and perception on

stop working due to COVTD-19

Table 3.22 Association between mental health problems and healthcare

workers’ fcarol SARCoV-2 infection 40Table 3.23 Association between mental health problems and and health care

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

survival if infected with SARS-CoV-2 - 42Table 3-25 Association among axntal health problems and perception on the

exposure risk to COVID-19 among respondents .43

Figure 1.1 lhe structure of coronavirus causes acute respirator)- syndrome in

Figure 1.2 History of coronavirus naming during the three zoonotic outbreaks

in relation to vims taxonomy and diseases caused by these virusesóFigure 1.3 The main hosts and the method of infusion of Coronavirus

(suspected hosts SAR.S-CoV-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

Rearonale : The COVID-1? pandemic has affected the economy, politics

in general, and people worldwide The global problem is how to cure patients with COVID-19 and keep the disease under control This issue is not only a challenging and urgent problem for the state, senior officials, and even the people Besides, few people concerned about healthcare workers’ mental health • the frontline force of disease prevention and treatment

Problem: The study aãned to determine tire mental health issues of healthcare workers in Vietnam during the COVID-19 pandemic because this issue has not been paid much attention in Vietnam Meanwhile, there are a lot

of research on this issue in the health force around the world I hope that this study will lielp policy makers have a timely solution to discover and support

by their medical staff and medical managers

Methods: We conducted n 2157 healthcare workers in Hanoi through

an online survey using snowball sampling technique

Results: The degree of symptoms of depression anxiety, insomnia, and distress was assessed by the 22-item Impact of Event Scale-Revised, rhree crucial factors related to the nrental health of healthcare workers found in the study are fear of infection, fear of infecting to family members, and fear of suffering the disease This problem drew the lesson that nor only citizents but also healthcare workers have concerns about COVID-19 in general

Conclusion: Our findings observed healthcare workers faced with mental health problems and therefore, theyare also needed sujipoit from the authorities, medical managets and families in terms of mental health

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

The outbreak of a new coronavirus infection (COVID-19) on 31 December 2019 among humans 111 Wuhan (China) spread quickly to others locations in both China and over the world Coronaviruses can cause cold with major symptoms such as fever, and a sore throat from swollen adenoids

2 The human coronavirus discovered in 2003 SARS-COV which causes severe acute respiratory syndrome (SARS), lias a unique pathogenesis because it causes both upper and lower respiratory' tract infections It is estimated tliat in the early stages, the mortality rate of epidemics worldwide is estimated to be about 2% with the majority of deaths occurring in special populations such as background pathology', weakened immune system and the elderly people 4 In the face of the complexity of the epidemic, on March 11

2020 WHO officially declared the outbreak of acute respiratory infections caused by the new strain of lire Corccta virus as a ‘ Global Pan-Epidemic" 3 and as of mid-April 2020 more than 200 countries have recorded epidemics with the total number of cases having reached millions and hundreds of thousands of deathss As of 20 April 2021 there have been at least 3 032 124 confirmed deaths and more than 142 23S 073 confirmed cases in the COVID-

19 pandemic and OCCU1 ing in all countries in the world ổ

COVID-19 raises an increasing amount of information and concerns are impacting on global mental health Global media, local and international health organizations (including World Health Organization), epidemiologists, virologists and opinion-makers pul out information, recommendations and minute-by-minute updates on COVID-19 spreading and lethality Nevertheless the burden of this infection on die global mental healtli is currently neglected even if it may challenge patients, general population, as well a? policy makers and health care workers

such as the Brazil UK China ? In Vietnam on May 19 2021 there were 4.543 cases of COVID-19; 37 deaths and 2.687 recovery cases Hanoi Da Nang Quang Nam and Ho Chi Minh Chy are the provinces with the highest number of COVID-19 cases in Vietnam Thus, we conducted research

"Evaluating the psychological impacts related to COVID-19 or healthcare workers and associated factors in Hanoi 2020" with two following objectives;

/ To describe the psychological impacts ofheahhcure workers during the COỈ 7D-J 9 pandemic tn Hanoi, 2020

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

Chapter 1LITERATURE REVIEW1.1 Basic concepts

ỉ.1.1 Definition of mental health and health workers

According to the World Health Organization's 19"8 Declaration at Alma Ata: "Health is a state of complete comfort both physically, mentally and socially rather than just without disease or disability" Comprehensive health

in every human being consists of three components; physical health mental health and social health I0

As defined by the Vietnam Psychiatric Society: ••Mental health is a state

of not only no mental disorders or malformations but also a completely relaxed mental state: to have a relaxed mental state that needs to have a good quality of living, to have a balance and harmony between individuals, people around and the social environment’*n

Healthcare human resources - also known as healthcare workforce or health care workers - are defined as "all those involved in actions with the primary purpose of improving health”, according to the World Health Organization's 2006 tepott Medical human resources are identified as one

of the main pillars of a health system They include doctors, nurses, midwifes, dentists, pharmacists others working in the health sector Other healthcare workers may include community health workers, social health workers and other health care providers, as well as health support and managnnent workers Those who do not provide direct medical senices, but essential for tile health system to function effectively such as health service managers, medical records and health information technicians, health economists, health supply chain managers medical clerks and others

I 1.2 Definition ớflứstởryofCOllD-19 att(t iititũtion

J í.2.1 Definition of Corona vùriB

The name “Coronavirus" IS derived from the Lahn corona, which means crown or aura, and refers to the characteristic appearance of the virion under

an electronic microscope with a large fringe, which forms an image such as a royal crown or corona : \

Coronavirus (also known as corona virus) is a group of vintses of the sub family Caonasirinae in tlx? family Coronaviridae according to the Order Nidonrales Coronavirus causes disease in mammals, including humans and birds u

Corona virus was detected in the 1960s li The first people found to be infected with the infectious bronchitis virus in chickens and two viruses from the nasal cavity of patients with the common cold were named human coronaMtus 229E and human coronaviIUS OC43 In humans, the virus that causes respirator}’ 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)11

2 Virus coronavirus OC43 (HC0V-OC43) 19

3.SARS-C0V (2OO3)20

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

5 Human coronavirus HKUl (2005)20

6 Middle East respiratory' syndrome-related ccronaMnis (MERS-CoV).P-Cov»

7 SARS-CoV-2 (2019) *

In animals, coronavirus also causes a wide range of diseases in farm animals and domesticated livestock, some of which can be serious and pose a threat to the agricultural sector;1 In chickens, the Infectious Bronchitis Virus

(IBV) a type of coronavirus, is aimed not only at the respiratory tract, but also the urinary tract The virus can sptead to various bodies throughout the chicken bod}-Important economic coronaviruses of fann animals include coronavirus pigs (infectious gastroenteritis coronavirus TGE) and cow coronavirus, which both result in diarrhea in young cattle

I.Ỉ.2.2 Definition of virns SARS-Col'-2

Severe acute respiratory' syndrome corona virus 2 formerly known as the new corona virus 2019 (2019-nCoV), is a coronavirus strain that causes acute respiratory infections caused by corona virus 2019 (COV1D-19):o

Flgitre Ỉ.Ỉ The structure of coronavirus cattvs acute respiratory syndrome

in Itumans

On January 12, 2020 it was named 2019-nCoV by the Work! Health Organization, based on a method of naming the new corona virus :1 On 11 February 2020 the International Commission on Virus Classification (ICTV) decided to officially name this new strain of corona virus SARS-CoV-2 when they analyzed that it was the same species as the SaRS virus that caused the

2003 epidemic but is another strain of tlie species Although relevant these two viruses are different WHO announced "COVID-19" as the name of the new disease on 11 February 2020 following previously dev eloped guidelines with the World Organization for Animal Health (OIE) and the Food and Agriculture Organization of the United Nations (FAO) ;ỹ

Seven acute respiratory syndrome iota led coron»vifus

A First name * Name origin

Figure 1.2 History of coronavirus naming (luring the three zoonotic outbreaks in relation to virus taxonomy and diseases caused by these

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

SARS-CoV-2 virus spread faster than its two ancestors SARS-CoV-l and MERS-CoV but had a lower mortality rate

1.1.2 J Pathological features and origin of cot 7D-Ỉ9

COVID-19 is an acute respiratory disease caused by a novel emerged coronavirus- SARS-CoV-2 33 In 2003 China's population was infected with a virus that causes Severe Acute Respiratory Syndrome (SARS) in Guangdong Province 34 The virus has been confirmed as a member of the Bera- coronavirus subgroup and has been named SARS-CoV-l Infected patients present with pneumonia symptoms with diffuse alveoveic lesions leading to acute respiratory distress syndrome (ARDS) 3Í SARS initially appeared in Guangdong China and then spread rapidly globally with over 8000 infected people and 776 deaths 3* A decade later in 2012 several Saudi nationals were diagnosed with another type of coronavirus 3 The virus was found to have been confnmed as a member of úie coronavirus and was named Middle East Coronavirus Respiratory Syndrome (MERS-CoV) 3? The World Health Organization reports that MERS-CoV has infected mope Ilian 2428 individuals and S38 deaths 3I MF.RS-CoV is a group of beta-coronavirus members and is diverse in genotypes from other Co-humans3P MERS-CoV infection begins wilh

a mild upper lespiiatory injury vvliile progression leads 80 serious respiratory disease ” Similar to SARS-CoV-1 patients with MERS-CoV infection with pneumonia, followed by ARDS and renal failure

Recently, is late 2019 WHO was notified of a number of cases of pneumonia with unfamiliar causes by the chinae gov eminentl The outbreak began at die human seafood market in the Chinese city of Wuhan and quickly infected more than 50 people ' Live animals commonly sold at The South China seafood market such as bats, frogs, snakes, birds, marmots and rabbits

40 On January 12 2020 China's National Health Commission released more details on rhe epidemic, recommending viral pneumonia From the analysis

based on The order of isolation front the patients, the virus was identified as a new type of coronavirus Moi cover, genetic order is also provided for the diagnosis of viral infections, lhe urns with single-threaded RNA named Coronavirus-2 Acute Respiratory Syndrome (SARS-CoV-2) has been isolated from a patient with pneumonia and connected to a group of cases of acute respiratory disease from Wuhan COVID-19 is the third known coronannis after S/XRS and Middle East Respiratory Syndrome (MERS)

SaRS-CoV-1 and MERS-CoV are also in the group coronavirus Genetic analysis has revealed tliat it is closely I elated to SARS-CoV-1 and generic clusters in the genus Betaooronavirus I lie Sarbecovirus sub-gene ■*’

Initially, it was suggested that patients infected with coronavirus pneumonia in Wuhan in China may have visited the seafood market where live animals 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 South China Sea seafood market and cannot exclude the possibility of human- to-human transmission The WHO report suggests that SARS-CoV-2 can be detected in environmental sanpies collected from the aquatic market, but has not yet 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 coronarinis and a coronavirus of unknown origin By comparison with other animate, they found 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 researdỉ supports the theory that transmission sequences start from bars to person Chan et al and Hui et al have confirmed that SARS-CoV-2 is a new type of coronarirus closely related to SARS-CoV-2 bats Recently Zhou et al and

Wu et al discovered a similar equation between SARS-CoV-2 and SAR.S- CoV-1 of "9.5% They also found that SARS-CoV-2 is highly similar to

eoronarinis bats Therefore current evidence strongly supports that SARS- CoV-2 is derived from bats although the intermediate hosts of SARS-CoV-2 are still identified.

However further investigations show that some indriidwils are infected even without a record of visiting the seafood market These observations showed the virus's ability to spread from person to person, which has since been reported in more than loo countries around the world The human-to- human spread of the virus 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* trad through the nose or mouth

Figure 1.3 The main hosts and the method of infusion of Coronavirus

(suspected hosts SARS-CoV-2 are surrounded in red)

Only u and p coronaviruses arc capable of infecting humans, the consumption of infected animals as a food source 1$ the main cause of the animals transmission of the virus to humans and due to close contact with an infected person, the virus continues to spread to healthy people The dotted black arrow shows the ability to transmit viruses from the bat while the characteristic black arrow represents the transfer

The origin and transmission are importantly identified to develop preventive strategies to prevent infection In the SaRS-CoV-1 case, the researchers initially focused on panda dogs and civet dogs as a primary of infection However, only isolated samples from civets in the food market showed positive results when viral RN’A was detected, suggests that civets may be a second host In 2001 samples isolated from healthy Hong Kong people and molecular evaluation showed 2.5% anti-body anti-SARS- eoronavtrus rate These signs show tliat SARS-CoV-1 may have circulated in humans before causing the outbreak in 2003 Subsequently, tlr rlino bat was also found to have anti-SARS-CoV-1 antibodies indicating tliat the bat was a source of viral replication Coronavirus syndrome in the Middle East (MERS) first appeared in 2012 in Saudi Arabia MERS-CoV is also associated with beta-coronavirus and has camels as the primary source of animals or hosts In

a recent study MERS-CoV was also detected on the bats Pipistrellus and Penmyotis, claiming that bats are the main host and means of transmission of diseases of the virus 45 Initially, a team of researchers suggested that snakes were possible boats, however, after discovering the genome similarity of the new coronavirus to the SARS- like bat virus supported the claim that not snakes but only bats were the main reservoirs Further analysis of similar re­combining shows that glycoprotein is associated with receptors of newly developed coronaviiuses from SARS-CoV-1 (CoVZXC21 or CoVZC45) and Beta-CoV not yet known However, in Older to eradicate the virus, more work needs to be done in the aspects of determining the intermediate source of animals that cause the transmission of the virus to humans

All coronaviruses contain specific genes in the region below ORF1 that encode proteins to replicate viruses, nucleocapsids and form spines "6 Glycoprotein spines on the outer surface of the coronav inis are responsible for the attachment and penetration of the vims into host cells (Figure l.l)

Domain-linked receptors (RBDs) are loosely attached between viruses, so viruses can infect multiple hosts Other coronaviruses primarily recognize aminopeptidase or carbohydrates as an important cell to enter human cells

w hile SARS-CoV-1 and NlERS-CoV recognize exopeptidase The mechanism

of penetration 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 jxotein and produce further penetration changes MERS-CoV uses dipeptidyl peptidase 4 (DPP4) while HCoV-NL63 and SARS-CoV-1 require the enzyme to corner! angiotensin 2 (ACE2)as the main receptors

1.2 Psychological change* of healthcare worker*

In the fight against the COVID-19 epidemic, healthcare workers in Wuhan had faced enormous pressure, includitig high risk of infection and insufficient personal protective equipment, over-work, frustration, discrimination, isolation, patients with negative emotions lack of contact with tlieir families and exhaustion Senous conditions are causing mental health problems such as stress, anxiety, depressive symptoms, insomnia, anger and feat These mental health issues not only affect medical workerss attention and under'Standing but also to decision-making abilities This could hinder the fight against COVID-19 In addition, the COVID-19 epidemic has a long­term impact on overall health as well as affecting the quality of life and work

of healthcare work?!* 4?

COVID-19 has a significant impact on public health and poses challenges for healthcare workers, especially frontline medical workers that come into direct contact with patients with COVID-19 There haw been a number of studies talking about tile impact of the COMD-19 epidemic on the health, life and work of healthcare workers in particular and people in general Studies around the world show that the COXTD-19 epidemic can affect the

mental health of healthcare workers by increasing COVID-19 infection rates and increasing the incidence of insomnia fatigue, anxiety, depression or suffering for medical workers 4 A previous study revealed that the imposition of lockdown in Clina put more than 50 million people under quarantine to prevent the infection, leading to a "desperate plea” for hupport }l More than half of the participants rated the pandemic's psychological impact as moderate or severe and about one-tltird of them reported moderate

to severe anxiety symptoms ■ Research studies from Iran and Japan also highlighted the seriousness of the COVID-19, misinformation social isolation resulting in mental health problems, and a high level of panic behavior, such

as stockpiling of resources in the population 515i.The severe acute respiratory syndrome (SARS) epidemic in 2003 was positively related to a high level of anxiety among recovered patients and the risk of suffering from post-traumatic stress disorder among those who survived life-threatening condition 54 55 In the HlN'l influenza outbreak, the general public also revealed fears about the probability of contracting the virus 'Lessons learned from previous epidemics show that assessment and interventions play a critical role in mitigating the psychological issues, esjieciallv among healthcae workers ■**

Because of COXTD-I9 Vietnam, a developing country, was on higher alert due to its land border with China and overseas travel between two countries related to business and tourism The government of Vietnam imposed 'Social distancing and social isolation*' at the beginning of April

2020 to mitigate the spread of COVID-19 with prompt contact tracing and quarantine • Social distancing or “physical distancing** means that one person keeps a safe space (about 2 arms' length) from other people who are not fian their household in both indoor and outdoor spaces For the first time

in Vietnam, people have undergone "social distancing" to minimize infectious disease transmission Although, these deliberate preemptive strategies bring

positive- effects on slowing down of positive tests, abiding by social distancing may ramp up profound impacts on the mental health of medical workforce and local citizens s? Healthcare workers forced to live temporarily

in tbe healthcare center to treat for patients and isolate with their family Emotional distress stressors include financial losses, the fear of COXÌD-19 infection, and severe shortages of personal protective equipment i9- Previous studies suggested dial people with different social-economic backgrounds aid Iristory’risk of exposure to the COVID-19 experienced a different severity level of mental health problems 6: *•'

u Related factors with mental health problems of healthcare workersThe previous study used 37 filll-text articles during July 2020 using Google scholar PubMed as databases to critically evaluate the related factors that demonstrated an influence on psychological and menial health during the COVID-19 pandemic over lhe world 5’ In Taiwan COVID-19 pandemic caused sleep distutbances and suicidal thoughts in healthcare workers w Ill China the SARS-CoV-2 epidemic brought high levels of psychological distress, insomnia, alcohol, and drug misuse, and symptoms of post-traumatic stress disoidei (PTSD), depression, and liigliet perceived stress primarily on medical siaff and all healthcare and emergency workers, which seem to be the most affected categories Huang and Zhao (2020) observed higher lex-els

of stress related to how often people think about the epidemic 6i Concerning suicide cases, in India the results of the qualitative analysis enlighten underlying reasons, such as fear of COVID-19 infection, financial crisis, loneliness, social boycott, pressure lor quarantine, fear of positixe COMD-

19 and pre- and post - lockdown work-1 elated stress

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

"social distancing” lime, at rhe individual level, mass ho me -confinement directives (quarantine or self-isolation) are associated with numerous adverse emotional outcomes such as depression, boredom, irritability and stigma related to quarantine Healthcare systems were not prepared to deal with the pandemic and healthcare workers have dealt with shortages of recommended supplies including gowns, masks, face shields, and respirators, which paid massive pressure on individual medical worker 1 AS the number of cases increased and nonessential senices in hospitals were stopped, healthcare systems across Viet Nam redeployed some healthcare workers and furloughed man}' Private practices also were affected, reducing staff as patient volumes fell and clinic visits were replaced with telemedicine ° One area of primary concern to most frontline workers is the safety of their families Healthcare workers limit physical contact with family members, wear protective equipment at home, or isolate at home Some clx>se to live away from their families to minimize the risk of ũral transmission.

In addition, the consequence of Hie loss of meaningful connections, confronting a pervasive impairment of society and difficulty in ensuring safe medical cate for all patients w ilhin huge workload can increase lire risk of psychiatric illness attributed to COX7D-19 *b'5

Chapter 2

METHODOLOGY

2.1 Study duration and location

- Duration: The study was conducted from April 2020 to April 2021 The data was collected in April 2020 (in two weeks during th? 1” national lock down in Vie Ina ni)

- Location: Survey online - survey of medical staff, research was conducted at medical facilities COV1D-19 ưeatmeni facilities and disease control center (CDC) in Ha Noi city

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

• Had a w orking duration of al least 6 months or more at the study tune

• Agreed Io participate in the Mudy.

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

2.4 Simple size And sampling method

> Sample size for quantitative research (survey online)

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

n

Of which;

n: minimum sample size

Z| <2: the corresponding value of tlie 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) 4

d: absolute precision ofp d 0.02

Thus, sample size was n = 794 In fad we recruited 2157 health workers

in the stud)'

Sampling: Snowball sampUqg technique was applied to recniil participants At the beginning of the recruitment process, a cote group of Hanoi Medical University was set up

The core group had a higher probability of knowing other people through medical students (fomvr and curent) and staff at different medical Universities in Vietnam We selected groups to reflect the diversity of study subjects, including age gender, and occupation throughout die country By sending the link to access the questionnaire from their deskstop or laptop for sun cy participation, the core group 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 were instructed to invite Oilier Vietnamese•people to join in the survey Study participants included healthcare workers in hospitals, health care centers, medical universities staff throughout healthcare

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

25 Study variables and indicators

- Demographic characteristics: genders, age ethnicity, religion, marital status, education level, living status

- Occupational characteristics: level of hospital, job types, working department length of work experience, occupational status

• Mental health problem measured by the corresponding subscales of the 22 item Impact of Event Scale revised (IES-R) IES-R is a well-established reported instrument to measure the affect of routine life stress everyday traumas and acute suess The Vietnamese version of IES-R was a validated tool to measures psychological dilemma 75 Response categories for these items are on a five-point scale “Strongly disagree” “Disagree" “Normal” “Agree" and "Strongly agree" (range 1 5) A sum of w eighted item scores was used as a scaled score according to the following calculation formula

Total score « QI * Ọ2 ♦ * Ọ2M Q22

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

2.Ó Dau collection tool and method

- A self- administered questionnaire consisting of 4-4 questions in forms

of single-choice, multiple-choice, and open-ended questions pertaining to rhe 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 die one used for assessing life and job impacts due to SARS pandemic

- Demographic characteristics-, we included questions to measure sociodemographic characteristics including age goups gender

(male, female), marital status (single/separated'windowed-married) living status, educational level.

- Information regarding the impact of COVID-Ì9: Ibe response was recorded in five-point Likert scale (l=strongly disagree; 5=strongly agree) with score of 1 to 2 taken as negative response, and 3 to 5 as positive response The scores obtained for intrusive-avoidance items in the IES revised was analysed as ‘’high" or "low" scores, equivalent with "yes" or “no" suffering the mental health pioblems and the 24 score was used as cutt-off point \

2.7 Data management and analysis

Quantitative data were entered and cleaned using Epidata 3.1 software and analyzed using STATA 14.0 software

•Descriptive statistics are used to calculate frequency and percentage of each variable, thereby assessing the mental health of the COVID-19 pandemic

on medical workers

♦ Infetence statistics by statistical tests for the qualitative MuiaUe is using a single or multivariate logistic regression model to determine the effects of COVID-19 on mental health of medical workers on dependent and indepent variables Select variables into multivariate regression by using single logistic regression on STAT A 14.0 and then multivariate regression analysis with significant univariate regression variables Independent variable was demographic characteristics, occupational characteristics and risk of exposure Dependent variables were the 22-item Impact of Event Scale revised (IES-R) p-value w as at 0.05 level

• Impact of Event Scale revised (IES-R) was used to measure intrusive and avoidance items made by Vietnamse people during stressfull life event such as COVID-19

2.8 Bbs and control

• Bias

- Bias recall

- Bias related to designing data collection tools

- Unclear questionnaire items and illogical move from one question item

-Checking and re-checking data Regarding to the missing information,

it must be immediately tilled out either directly at the surveying settings or indirectly through the phone line and e-mail

- Double data entering for cross checking, any mistake identified would

be checked 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 information about the research and agree to voluntarily participate in the study

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

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

The results of rite 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

Chapter 3RESULTS

3.1 Demographic cbaracterislics of respondents

Table 3 J 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 (05.83%) In terns of age the majority of participants was 30-39 years old

(43.12%) with rhe average age was 36.32 years (SO S.60) Respondents having college /university degree was the highest percentage (64.02 %) meanwhile the lowest percentage were participants having lower degree (3.25%) The majority of study subjects were married (81.87%) and living with family / friends (95-32%).

EDUCATION LEVEL OF RESPONDENTS

OOP.

figure 3.1 The percentage of education levci of respondents

Table 3.2 Occupational characteristics of respondents

District healthcenter

Table 3.2 shows the occupational characteristics of respondents More than half of participants worked in district health centers (65.83%) followed

by respondents working in central level with 24.83% The portion of respondents who worked as nurses and doctors were 45.9% and 29.25% respectively Hie percentage of participants who worked in internal medicine was 13.58%^ followed by the data of emergency- intensive care with 13.17%; meanwhile the figure for infectious disease- infection control was only 3.71% The proportion of participants* job age over lo years, under 5 years and 5-9 years were 45.53%, 28.42% and 26.05%, respectively; with the median job age was 11.55 years (SE>- 8 41) There was 7724% respondents being official workers, while the data of full-time contract without term was 11.54%

Full-time contract within term

DEPARTMENTS OF RESPONDENTS

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3.2 The mental health problem of res pond cuts during the CO\1D 19 pandemic

Table 3 J Mental lieMIt problems among studyparticipants through IES’~ti score

Table 3.3 indicates the proportion of the total IES-R score winch was graded for severity frctn normal (0 23) mild (24 32) moderate (33 36) and severe psychological impact (> 37) The study participants had mental health problem was 20.829« In which, lite percentage of participants winch were graded in severe, mild and moderate subscale were 10.5 29-0 8.21% and 2.09%, respectively

Table 3.4 Level of mental health problem through gender

Table 3.4 indicates the level of mental health problem through gender The percentage of female respondents being mild and moderate level was about two times as high as the figure of male co-partners Besides, the data of female respondents being severe level was 16.04% higher Ilian that of male colleages

J able 3.5 Lewi of mental health problem through age groups

Table 3.5 illustrates the level of mental health problem through age groups Il is evidence that the portion of tile 18-25 age group suffering mental health problem in each level was the lowest among tire data of others age groups (normal: 6.09%; mild: 3.95% moderate: 5.00°b! severe: 5.19%) Meanwhile, the figure for the 31-40 years old group was the highest among oihers respondents (normal 4327%; mild: 40.68%; moderate: 41.67%; severe: 44.34%)

ĩaừle 3 j 6. Level of mental health prat)lem through working department

ClassificationWorking

department

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was less likely to suffer mental health problem (mild: 5.08% moderate: 1.67% severe: 425%) Tile percentage of participants working ill Imaging diagnosis- scientific laboratory- clinic and Administrative offices had morderate level was 1833% The Internal medicine accounted the highest percentage in severe level with 16.98%.

ClassifkaiioD

Table 3.7 Level of mental health problem through fob types

Table 3.7 presents the level of menial health problem through job types

It is dear that the propotion of nurses suffering mental health problem in each level was the highest among the data of others job types (mild: 50.28% moderate: 3833%; severe: 45.28%); followed by the figuie for doctors (mild:

29 94%; moderate: 26.67%; severe: 29.25%)

Table 3.8 level of mental health problem through length of work

3.3 Some factors associated with mental health problems of respondents

Table 3.9 Association between mental health problems and age group

NEXT AL HEALTH PROBLEMAft

Table 3.9 indicates The association between mental health problems In COVID-19 pandemic and age groups Participants who had the age from to

25 years old were less likely to suffer mental health problems in COVID-19 pandemic than the age of 26-30 (OR= 1.30 95HCI= 0.78-2.17), 31-40 (OR=1.28 95%CI = 0.78-2.10) and over 40 (OR= 141 95%CI = 0.85-2.34) However the association between age groups and mental health problems were not statistically significant ip>0.05)

Table J 10 Association befyreen mental health problems and gender

-Table 3.10 illustrates the association between mental health problems

in COVID-19 pandemic and gender Male participants were more likely to suftei mental health problems in COXĨD-19 pandemic (OR 1.21 95°óCI’ 0.98-1.50) compared to their female counterparts The association between age groups and mental luealth problems were not statistically significant (p>0.05)