Stress and Associated Factors among Frontline Healthcare Workers in the COVID-19 Epicenter of Da Nang City, Vietnam
2. Materials and Methods
2.1. Study Setting and Design
2.3. Data Collection
- Socio-demographic characteristics: Age, gender, marital status, professional qualifications, years of working experience, healthcare facility where they practiced, whether they lived with a vulnerable person (i.e., children < 12 years; elderly persons; chronically ill persons).
- Working conditions: Total working time per week (in hours); night shift situation (yes/no). Self-perceived knowledge about infection control specific to COVID-19; self-perceived confidence in available personal protective equipment (PPE) such as masks, gloves, hand sanitizers, protective clothing for COVID-19 prevention at the workplace. Self-perceived data were collected using a 10-point Likert scale (1 = minimal level, to 10 = maximal level).
- Stress level: The stress component (7 questions) of the 21-item Depression, Anxiety and Stress Scale (DASS-21) was used to evaluate the stress status. Scores were dichotomized into normal stress (with scores between 0 and 14) and increased stress (with scores greater than 14). Increased stress was further classified into mild (with scores between 15 and 18), moderate (with scores between 19 and 25), severe (with scores between 26 and 33) and extremely severe stress (with scores greater than 33) .
- Self-perceived support for HCWs during the COVID-19 pandemic: A 10-point Likert scale (1 = not having support, to 10 = enthusiastic support) was used to measure the perceived support enjoyed by HCWs considering three sources of support: society, co-workers and HCWs’ families and relatives. A higher score indicated a higher level of support.
- Support from society: HCWs’ perception of the society’s support towards them, in the form of material support (such as provision of protective equipment) and non-material support (such as words of appreciation and encouragement through mail, mass media, social networks).
- Support from co-workers: HCWs’ perceptions of support, such as sharing of workloads, and mutual encouragement of colleagues.
- Support from family or relatives: HCWs’ perceptions of receiving encouragement, material support (such as food, bottled water, toiletries) and non-material support (such as phone calls, prayers) from family and relatives.
2.4. Statistical Analysis
2.5. Ethical Considerations
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
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|p||Overall||Experienced Stress||No Stress|
|Number of participants (%)||746 (100.0%)||333 (44.6%)||413 (55.4%)|
|Age in years: mean (SD)||32.8 ± 8.9||32.2 ± 8.7||35.0 ± 9.1|
|Sex: n (%)|
|Male||205 (27.5%)||96 (46.8%)||109 (53.2%)|
|Female||541 (72.5%)||237 (43.8%)||304 (56.2%)|
|Marital status: n (%)|
|Married||483 (64.8%)||210 (43.5%)||273 (56.5%)|
|Single or divorced||263 (36.2%)||123 (46.8%)||140 (53.2%)|
|Living with vulnerable groups: n (%)|
|Yes||584 (78.3%)||254 (43.5%)||330 (56.5%)|
|No||162 (21.7%)||79 (48.8%)||83 (51.2%)|
|Work experience (years): median (IQR) *||6 (2–11)||5 (2–10)||7 (2.5–12)|
COVID-19 treatment units
Not treatment units (city CDC and others **)
|Stress Levels||Number (%)|
|Normal stress (score ≤ 14)||413 (55.4)|
|Increased stress (score > 14)||333 (44.6)|
|Mild (15 ≤ score ≤ 18)||108 (14.5)|
|Moderate (19 ≤ score ≤ 25)||84 (11.3)|
|Severe (26 ≤ score ≤ 33)||116 (15.5)|
|Extremely severe (score > 33)||25 (3.3)|
|Overall stress scale score: median (IQR)||14 (6–22)|
|Factors||OR adj *||p||95% CI|
|Total number of working hours/weeks||1.012||0.002||1.004||1.019|
|Support from co-workers||1.005||0.943||0.885||1.141|
|Support from family or relatives||0.987||0.825||0.879||1.108|
|Support from society||0.916||0.051||0.838||1.001|
|Confidence in the available personal protective equipment||0.846||0.011||0.744||0.962|
|Self- reported knowledge of COVID-19 prevention and treatment||0.853||0.031||0.739||0.986|
|Pharmacist, public health officer and others||Ref|
|Physician, nurse, laboratory worker||1.42||0.039||1.02||1.99|
|Not treatment units (city CDC and others **)||Ref|
|COVID-19 treatment units (public hospitals in city and district, private hospitals in city)||1.58||0.032||1.04||2.39|
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Nguyen, N.P.T.; Le, D.D.; Colebunders, R.; Siewe Fodjo, J.N.; Tran, T.D.; Vo, T.V. Stress and Associated Factors among Frontline Healthcare Workers in the COVID-19 Epicenter of Da Nang City, Vietnam. Int. J. Environ. Res. Public Health 2021, 18, 7378. https://doi.org/10.3390/ijerph18147378
Nguyen NPT, Le DD, Colebunders R, Siewe Fodjo JN, Tran TD, Vo TV. Stress and Associated Factors among Frontline Healthcare Workers in the COVID-19 Epicenter of Da Nang City, Vietnam. International Journal of Environmental Research and Public Health. 2021; 18(14):7378. https://doi.org/10.3390/ijerph18147378Chicago/Turabian Style
Nguyen, Nhan Phuc Thanh, Duong Dinh Le, Robert Colebunders, Joseph Nelson Siewe Fodjo, Trung Dinh Tran, and Thang Van Vo. 2021. "Stress and Associated Factors among Frontline Healthcare Workers in the COVID-19 Epicenter of Da Nang City, Vietnam" International Journal of Environmental Research and Public Health 18, no. 14: 7378. https://doi.org/10.3390/ijerph18147378