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

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ACKNOWLEDGMENT
First and foremost. I would like to acknowledge to my thesis advisorAssoc. Prof. Le Thi Thanh Xuan who had directly guided and created necessary
conditions for me to participate in Illis research. With her dedication, patience,
intellectual guidance. I had a precious opportunity to learn more about academic
skills along with accomplishing my final thesis.
My journey along with this research allowed me to come in contact with
medical managers and healthcare workers. Their thorough, objective renews
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 the research.
The successful navigation through the university met various obstacles that
would not have been suipassed without the guidance from all lecturers of Hanoi
Medical University; particularly lectureis from School of Preventive Medicine
and Public HealtíL
Last but not least, mam' thanks were given to my family and friends who
encourage me throughout the period of difficulties.
Hanoi. 25* May 2021

Tran Thỉ Thuy Lỉnh

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DECLARATION
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 as

one of the main investigators. The- results and figures in this research collected
are accurate and have not been published and reported in any other publications.
I will be responsible for any delusion detected.
Hanoi. 25* May 2021
The Author
Tran Thí Thuy Linh


CONTENTS

3.1. Some factors associated with mental health problems of respondents 29

REFERENCES
APPENDIX 1
APPENDIX 2

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ABBREMATIOXS
ARDS
CDC

Acute Respiratory Distress Syndrome
Disease Control Center

IES-R
ILO

Impact of Event Scale - Revised
International Labor Organization

MERS-CoV
PPE

Middle East Coronavirus Respiratory
Syndrome
Personal Protective Equipment

SARS

Severe Acute Respiratory Syndrome

SARS-CoV-2
WHO

Corona\irus-2 Acute Respiratory Syndrome
World Health Organization

PTSD

Post Traumatic Stress Disorder
LIST OF TABLES

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 3.21. Association between mental health problems and perception at


LIST OF FIGURES

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ABSTRACT

Reasonale : The COVID-19 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 aimed to determine tire mental health issues of
healthcare workers in Vietnam during the COVID-19 pandemic because this
issue lias not been paid much attention in Vietnam. Meanwhile. there are a lot of
research on this issue in tire health force around the world. I hope that this study
will help 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. Three
crucial factors related to the mental health of healthcare workers found in tire
study are fear of infection, fear of infecting to family members, and fear of
suffering the disease. This problem drew the lesson that not 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 support from the authorities,
medical managers, and families in terns of mental health.
Key words : The COVID-19 pandemic, healthcare workers, mental health


INTRODUCTION

The outbreak of a new coronavirus infection (COVID-19) on 31
December 2019 among humans in 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 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 background pathology, weakened
immune system and the elderly people ’. 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 sttain of the Corona virus
as a “Global Pan-Epidemic" 5 and as of mid-April 2020. more Ilian 200
countries have recorded epidemics with the total number of cases having
reached millions and hundreds of thousands of deaths 6. As of 20 April
2021. there have been at least 3 032 124 confirmed deaths and more than
142 238 073 confirmed cases in the COVID- 19 pandemic and occuring in
all countries in die world6.
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 put out information, recommendations and minute-byminute updates on COVID-19 spreading and lethality. Nevertheless, the burden
of this infection on the global mental health is currently neglected even if it may
challenge patients, general population, as well as policy makers and health care
workers.


Although there have been many- studies on mental health during the
COVID-19 epidemic, most are concentrated in countries with large outbreaks
such as the Brazil. UK. China ' 9. 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 C1Ú Minh City are the provinces with the highest number
of COVID-19 cases in Vietnam. Thus, we conducted research “Evaluating the
psychological impacts related to COVTD-19 of healthcare workers and

associated 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 of
relative
factors
with in
theHanoi, 2020
psychological
impacts
healthcare
workers


1
1

Chapter 1
LITERATURE 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 Alina
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 10.
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 envứonment” 1!Healthcare human resources - adso 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 report i:. Medical human resources are identified as one of
the maul 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 management workeis. Those
who do not provide direct medical services, but essential for the health system to
function effectively such as health senice managers, medical record; and health
information 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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1
2

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 13.
Coronavirus (also known as corona virus) is a group of viruses of the sub
family Coronavirinae in the family Coronaviridae. according to the Order
Nidovirales. Coronavirus causes disease in mammals, including humans and
birds u.
Corona virus was detected in the 1960s '••. 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 coronavirus
229E and human coronavirus OC43

:6

. In humans, the virus that causes

respiratory infections is usually mild but rare cases can be fatal 1?.
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). 0CoV 20
7. SARS-CoV-2 (2019)2:20

In which
diseases
animals,
inVirus
coronavirus

farm
animals
also
and
causes
domesticated
athe
wide
livestock,
range
of
agricultural
can
be serious
sector
. In
and
chickens,
pose
a threat
Infectious
to
the of some
Bronchitis

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

1.1.2.2.

Definition of virus SARS-Col -2

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1
3

Severe acute respirator}.' syndrome corona virus 2. formerly known as the
new corona virus 2019 (2019-nCoV). is a coronavirus strain tliat causes acute
respiratory 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 Health
Organization, based on a method of naming the new corona virus

24

. 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 the species 2J. Although relevant, these two
viruses are different. WHO announced "COVID-19" as the name of tire new
disease on 11 February 2020. following previously developed guidelines with the

World Organization for Animal Health (OIE) and the Food and Agriculture
Organization of the United Nations (FAO)24.

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1
4
Virus Middle

EăSỈ respite tery species
syndrome-related 4 coronavirus
g

Severe acute
rẻsptrăỉõry
syndrome-related
coronavirus

ICTVCSG

D
<
0
n
v

Virus

c
i
t
o
z

WHO

Disease

MERS-CoV *

SARSCoV

▼

t1

Middle East
respiratory syndromo
(MERS)

Severe acute
respiratory syndrome
(SARS)

2012

▲
2003

Year

► SARS-CoV2
Coronaviru
s
disease
(COVID19)
2019

Figure 1.2. History of coronavirus naming during the three zoonotic
▲ Firs! name ► Name ongm

outbreaks in relation to virus taxonomy and diseases caused by these
viruses
The gene sequence of the SARS-CoV-2 virus strain consists of a single
RNA sequence of 29.903 nucleotides 2i. In terms of similarities, it is:
50% of the gene code compared to the MERS-CoV virus strain *'6; 79.5%
gene code compared to SARS-CoV virus strain26;
96% of the gene code compared to corona virus strains detected in bats,
especially horseshoe bats26;
99% of die gene code compared to the Corona virus strain in pangolins 2’.
SARS-CoV-2 virus and SARS-CoV-1 virus belong to the same generation B
Corona virus (Betacoronavirus Lineage B. Sarbecovirus) ;s. This suggests that the
origin of the virus31was in pangolins or bats25UO.

Thisvirus
the
newly70%
that

discovered
coronavirus
the
2003 SARS
has
epidemic
a genome
(SARS-CoV)
similar to
by
more
than
.caused
The

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1
5

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 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. Tile virus lias been confirmed as a member of the Betacoronavirus
subgroup and has been named SARS-CoV-1 Infected patients present with

pneumonia symptoms with di fluse alveoveic lesions leading to acute respiratory
distress syndrome (ARDS) 3i. SARS initially appeared in Guangdong. China and
then spread rapidly globally with over 8000 infected people and 776 deaths ?i. A
decade later in 2012. several Saudi nationals were diagnosed with another type of
coronavirus3?. The virus was found to have been confirmed as a member of the
coronavirus and was named Middle East Coronavirus Respiratory Syndrome
(MERS-CoV) • . The World Health Organization reports that MERS-CoV lias
infected more tfian 2428 individuals and 838 deaths 3S. MERS-CoV is a group of
beta-coronavirus members and is diverse in genotypes from other Co-hunians

39

MERS-CoV infection begins witfl a mild upper respiratory injury while
progression leads to serious respiratory disease

35

. Similar to SARS-CoV-1.

patients with MERS-CoV infection witfl pneumonia, followed by ARDS and
renal failure39

40
4l
Recently,
cases
of
pneumonia
in
late

2019.
with
WHOsuch
unfamiliar
was
notified
causes
of
by
asold
the
number
Chinese
ofthe
government
market
in
the
*.
The
Chinese
outbreak
began
of
Wuhan
atJanuary
the quickly
and
human
seafood

infected
more
South
than
China
50
seafood
people
*.city
market
Live
animals
as
bats,
commonly
frogs,
at The
birds,
China's
marmots
National
and
Health
rabbits
Commission
. viral
O11
released
12.
more

2020.
details
analysis
on
the
epidemic,
recommending
pneumonia
.snakes,
From

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based on the order of isolation from the patients, the virus was identified as a
new type of coronavirus. Moreover, genetic order is also provided for the
diagnosis of viral infections. The virus 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 coronavirus after
SARS and Middle East Respiratory Syndrome (MERS). SARS-CoV-1 and
MERS-CoV are also in tile group - coronavirus i-. Genetic analysis has revealed
that it is closely related to SARS-CoV-1 and genetic clusters in the genus
Betacoronavirus, the Sarbecovirus sub-gene4S.
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- tohuman transmission. The WHO report suggests that SARS-CoV-2 can be

detected in environmental samples 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 coronavirus
and a coronavirus of unknown origin. By comparison with other animals, they
found that snakes were the most likely wildlife for SARS-CoV-

Benvenuto
closely
related
et
al’s
only
research
to
coronavirus
shows
that
isolated
SARS-CoV-2
from
was
bats
in
China
transmission
in
2015.
Their
research
start

from
supports
bats
theperson.
to
theory’
Chan
that
et
al
type
and
of
Hui
coronavirus
etsequences
al
have
closely
confirmed
related
that
to
SARS-CoV-2
SARS-CoV-2
is
bats.
a
new
Recently.

equation
between
Zhou
et
SARS-CoV-2
al
and
Wuis
et
and
al
SARSdiscovered
CoV-1
of
a
similar
79.5%.
They
also
found
that
SARS-CoV-2
highly
similar
to

coronavirus bats. Therefore, currait evidence strongly supports that SARS- CoV2 is derived from bats, although the intermediate hosts of SARS-CoV-2 are still
identified.
However, further investigations show that some individuals 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 lias

since been reported in more than 100

countlies

around the world. The human-to- human

M
M
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?


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 ttact through the nose or mouth.

IMWAC# 0» c. o
BUnsafe A

Figure 1.3. Hie main hosts and the method of infit»on of
Coronavirus

(suspected hosts SARS-Cot-2 are surrounded in red)
Only « and 3 coronaviruses arc capable of infecting humans, the
consumption of infected animals as a food source is the main cause of the
animal's transmission of the vims 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 tire 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 RNA was detected, suggests dial 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- coronavirus rate.
These signs show that SARS-CoV-1 may have circulated in humans before

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causing the outbreak in 2003. Subsequently, the rhino bat was also found to have
anti-SARS-CoV-I antibodies indicating that 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. MERSCoV was also detected on the bats PipistTellus and Perimyotis, claiming that bats
are 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, after
discovering file genome similarity of the new coronavirus to the S.ARS- like bat
virus supported the claim tlrat not snakes but only bats were the main reservoirs.
Further analysis of similar recombining shows that glycoprotein is associated

with receptors of newly developed coronaviruses from SARS-CoV-1
(CoVZXC21 or COVZC45) and Beta-CoV not yet known. However, in order to
eradicate the virus, more work needs to be done in the aspects of determining the
interrmdiate 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 coronavirus are responsible for
the attachment and penetration of the virus into host cells (Figure 1.1).
Domain-linked receptors (RBDs) are loosely attached between viruses. so
viruses can infect multiple hosts. Other coronaviruses primarily recognize
aminopeptidase or caibohvdrates as an important cell to enter human cells while
SARS-CoV-1 and NlERS-CoV recognize exopeptidase. The mechanism of
penetration of coronaviruses depends on the protease of cells including trypsinlike protease in the human airways (HAT), cathepsins and serine protease 2
(TMPRSS2) that separate the spiked protein and produce further penetration
changes. MERS-CoV uses dipeptidyl peptidase 4 (DPP4). while HC0V-NLÓ3
and SARS-CoV-1 require the enzyme to convert angiotensin 2 (ACE2) as the

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main receptors.
1.2.

Psychological changes of healthcare workers

In the fight against the COVID-19 epidemic, healthcare workers in Wuhan
had faced enormous pressure, including high risk of infection and insufficient
personal protective equipment, over-work, frustration, discrimination isolation

patients with negative emotions, lack of contact with their families and
exhaustion Serious conditions are causing mental health problems such as stress,
anxiety, depressive symptoms, insomnia, anger and fear. These mental health
issues not only affect medical workers's attention and understanding but also to
decision-making abilities. This could hinder the fight against COVID-19. In
addition, the COVID-19 epidemic lias a longterm impact on overall health as
well as affecting the quality of life and work of healthcare workers 4".

COVID-19
poses
challenges
lias
apeople
significant
for
healthcare
impact
workers,
on
public
especially
health
and
frontline
with
patients
medical
workers
COVID-19.
that

There
come
have
into
been
direct
a
number
contact
of
studies
on
the
health,
talking
life
about
and
the
work
impact
of
healthcare
of
the
COX1D-19
workers
epidemic
in
world

particular
show
andwith
that
the
COVID-19
in
general.
epidemic
Studies
can
around
affect
tile
the

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20

mental health of healthcare workers by increasntg COVID-19 infection rates and
increasing the incidence of insomnia, fatigue, anxiety. depression or suffering for
medical workers 1 ■50. A previous study revealed that the imposition of lockdown
in China put more than 50 million people under quarantine to prevent the
infection, leading to a "desperate plea" for support

51

. More than half of the

participants rated the pandemic’s psychological impact as moderate or severe,
and about one-third 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 liigh level of panic behavior, such as stockpiling of resources in the
population 5“ ?s.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 }5. In the H1N1 influenza outbreak, the general public
also revealed fears about tire probability of contracting the vims ". Lessons
learned from previous epidemics show that assessment and interventions play a
critical role in mitigating the psychological issues, especially among healthcare
workers56.
Because of COVID-19. Vietnam, a developing country, was on higher
alert due to its land bord?r 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 anus' length) from other people who are not from 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

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21

profound impacts on the mental health of medical workforce and local citizens - s.
Healthcare workers forced to live temporarily in the healthcare center to treat for
patients and isolate with their family. Emotional distress stressors include
financial losses, the fear of COVTD-19 infection, and severe shortages of
personal protective equipment 59' 60. Previous studies suggested that people with
different social-economic backgrounds and history'risk of exposure to the
COV1D-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 using
Google scholar. PubMed as databases to critically evaluate the related factors
that demonstrated an influence on psychological and mental health during the
COVID-19 pandemic over tire world 65. In Taiwan COVID-19 pandemic caused
sleep disturbances and suicidal thoughts in healthcare workers In China, the
SARS-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 and
all healthcare and emergency workers, which seem to be tire most affected
categories 6M". Huang and Zhao (2020) observed higher levels 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 COVTD-19 infection financial crisis, loneliness, social boycott, pressure for
quarantine, fear of positive COVID- 19. and pre- and post- lockdown workrelated stress 6S.
As COVID-19 made its way to Vietnam, healthcare workers faced
uncertainty 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-confinement directives
(quarantine or self-isolation) are associated with numerous adverse emotional

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22

outcomes such as depression, boredom, irritability, and stigma related to
quarantine s. Healthcare systems were not prepared to deal with the pandemic
and healthcare workers have dealt with sltortages of recommended supplies
including gowns, masks, face shields, and respirators, which paid massive
pressure on individual medical worker s-

6:

. As the number of cases increased

and nonessential senices in hospitals were stopped, healthcare systems across
Viet Nam redeployed some healthcare workers and furloughed many. Private
practices also were affected, reducing staff as patient volumes fell and clinic
visits were replaced with telemedicine One area of primary concent to most
frontline workers is tire safety of their families. Healthcare workers limit
physical contact with family members, wear protective equipment at home, or
isolate at home. Some chose to live away from their families to minimize the risk
of viral transmission.

5
In addition,
connections,
thehuge
confronting
consequence
a pervasive
of
the
loss
impairment
of’■
meaningful
ofall
society
and
patients
difficult}’
within
in
ensuring

workload
safe
can
medical
increase
care
the
risk
of
psychiatric
illness
attributed
to
COVID-19
.for

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 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.
2.2.

-

Study population

Healthcare workers in health facilities (both hospitals and disease control
centers at different levels) in Hanoi.
Inclusion criteria:

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23

•

Healthcare workers (doctor and nurse) who directly participated in
examination, treatment and care for patients in hospitals with patients
infected with COVID-19.

•

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 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:
n
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 in
the study.
Sampling: Snowball sampling technique was applied to recruit participants.

At the beginning of the recruitment process, a core group of Hanoi Medical
University was set up.

The country.
core
group
had
aage.
higher
probability
of
knowing
other
people
staff
at
through
different
medical
medical
students
Universities
(fornw
and
in
curent)
Vietnam.
and
We
selected

subjects,
groups
including
toto
reflect
gender,
the
diversity
and
occupation
of
study
the
questionnaire
By
from
sending
their
the
deskstop
link
to
or
access
laptop
the
for
survey
participation.
closed

contacts
the
or
core
different
group
groups
able
to
by
access
social
to
network
their
(facebook.
involved
in
zalo).
the
study
The
contact
were
instructed
persons
who
to
invite
had

been
other
Vietnamese
participants
people
included
join
healthcare
in
the
survey.
workers
Study
in
hospitals,
healthcare
health
care
centers,
medical
universities
staff
throughout

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centers in Hanoi. A total of 2157 participants (hospital staffs, university medical
staffs) were selected for the sample during two weeks of data collection.
2.5.

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 22item 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
stress The Vietnamese version of IES-R was a validated tool to measures
psychological dilemma 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 weighted item scores was used as a scaled score according
to the following calculation formula:
Total score = QI + Q2+ ... + Q2I + Q22
-

Risk of exposure: perception of risk of exposure to COVID-19 through air
breath, 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 of
single-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 for assessing life and job impacts due to SARS
pandemic.

-

Demographic

characteristics:

sociodeinographic

we

characteristics

included
including

questions
age

to

measure

goups.

gender

(male/female). marital status (single/separated/uindowedmaiTied), living
status, educational level.

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