Assessing stress among community health workers due to COVID-19 related work: A comparative study from Vietnam

Background Community health workers (CHWs) involved in COVID-19 response might be at increased risk of stress, though evidence remains absent. Objective To assess the effects of COVID-19 related work on stress and identified factors associated with the risk of deteriorating to severe stress among CHWs in Vietnam. Methods Using a nation-wide survey among 979 CHWs involved in COVID-19 response, we applied multivariable logistic regression to estimate the risk of deteriorating to high stress levels between before the epidemic (average June-December 2019) and at its peak (January-March 2021). Stress levels were measured using the Perceived Stress Scale (PSS-10). Results Median stress levels among CHWs increased from 10 (IQR = 7-16) before COVID-19 to 15 (IQR = 11-19) on the PSS-10 during the COVID-19 outbreak. The proportion of CHWs with low stress levels decreased from 67.6% to 42.2% (p-value <0.001), while the proportion of CHWs with moderate and high stress levels increased 1.8 and 4.2-fold, respectively. Less sleep and poor sleep quality, working in unfavorable work environments, and being involved in daily high-risk SARS-CoV-2 exposure activities were associated with an increased risk of deterioration to high stress levels. Conclusions We found a substantial increase in stress levels among CHWs in Vietnam that is probably due to their COVID-19 related work; the observed 2 and 4-fold increase in CHWs suffering from moderate and high stress levels, respectively, is particularly worrisome. Targeted support for CHWs is crucial to ensure the sustainability of health interventions during COVID-19 and future epidemics.