National Centre for Epidemiology and Population Health, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, ACT, Australia.
National Institute of Hygiene and Epidemiology, Hanoi, Vietnam.
Hum Resour Health. 2022 Aug 19;20(1):64. doi: 10.1186/s12960-022-00760-x.
Community health workers (CHWs) involved in the COVID-19 response might be at increased risk of developing depression, though evidence is scarce. We investigated effects of COVID-19-related work on changes in depression levels among CHWs in Vietnam and identified sub-groups among CHWs who are at particular risk of developing severe depression.
We conducted a cross-sectional online survey among 979 CHWs who were involved in the COVID-19 response in Vietnam, in particular during the 2021 Tet holiday outbreak between January and March 2021. Respondents were asked to report depression symptoms at two-time points, before the start of the COVID-19 pandemic (average June to December 2019) and during the 2021 Tet holiday outbreak using the PHQ-9 mental health questionnaire. We estimated depression levels at both time points and developed univariate and multivariable logistic regression models to estimate odds ratios and 95% confidence intervals (95% CIs) to explore the association between deterioration to high depression levels and selected risk factors.
Median depression levels among CHWs in Vietnam doubled from 3 (IQR = 2-7) before COVID-19 to 6 (IQR = 3-9) on the PHQ-9 scale during the Tet holiday outbreak. The proportion with normal/minimal levels decreased from 77.1% (95% CI = 74.4-79.7) to 50.9% (95% CI = 47.7-54) (p-value < 0.001), while the proportion of CHWs with moderate, moderately severe, and severe depression levels increased 4.3, 4.5, and five-fold, respectively. Less sleep and poor sleep quality, working in unfavorable work environments, and being involved in contact tracing and the organization of quarantine for suspected cases were associated with an increased risk of deterioration to high depression levels.
We found a substantial increase in overall depression levels among CHWs in Vietnam due to their COVID-19 related work and a particularly worrisome rise in CHWs suffering from severe depression. CHWs are an indispensable yet often overlooked cadre of work in many low- and middle-income countries and shoulder a heavy psychological burden during the COVID-19 pandemic. Targeted psychological support for CHWs is needed to improve their mental health and to ensure the sustainability of community-based health interventions during COVID-19 and future epidemics.
参与 COVID-19 应对工作的社区卫生工作者（CHWs）可能面临更高的抑郁风险，尽管证据有限。我们研究了 COVID-19 相关工作对越南 CHWs 抑郁水平变化的影响，并确定了 CHWs 中特别容易出现严重抑郁的亚组。
我们对 979 名参与越南 COVID-19 应对工作的 CHWs 进行了一项横断面在线调查，特别是在 2021 年春节假期期间（2021 年 1 月至 3 月）爆发疫情期间。受访者被要求在两个时间点报告抑郁症状，分别是在 COVID-19 大流行之前（平均 2019 年 6 月至 12 月）和 2021 年春节假期爆发期间，使用 PHQ-9 心理健康问卷。我们估计了两个时间点的抑郁水平，并制定了单变量和多变量逻辑回归模型，以估计恶化到高抑郁水平的比值比和 95%置信区间（95%CI），以探索与恶化到高抑郁水平相关的选定风险因素。
越南 CHWs 的抑郁水平中位数从 COVID-19 之前的 3（IQR=2-7）增加到春节假期期间的 6（IQR=3-9）。正常/轻度水平的比例从 77.1%（95%CI=74.4-79.7）降至 50.9%（95%CI=47.7-54）（p<0.001），而中度、中度严重和严重抑郁水平的 CHWs 比例分别增加了 4.3、4.5 和 5 倍。睡眠不足和睡眠质量差、在不利的工作环境中工作、参与接触者追踪和组织疑似病例隔离，与恶化到高抑郁水平的风险增加相关。
我们发现，由于 COVID-19 相关工作，越南 CHWs 的总体抑郁水平大幅上升，而严重抑郁的 CHWs 数量尤其令人担忧。CHWs 是许多低收入和中等收入国家中不可或缺但经常被忽视的工作队伍，在 COVID-19 大流行期间承担着沉重的心理负担。需要为 CHWs 提供有针对性的心理支持，以改善他们的心理健康，并确保在 COVID-19 期间和未来的疫情中社区为基础的卫生干预措施的可持续性。
