Mental Health Outcomes Among Healthcare Workers During and After the First COVID-19 Outbreak at a Thai Tertiary Hospital

Background: Healthcare workers (HCWs) caring for patients with coronavirus disease 2019 (COVID-19) face substantial psychological stress during pandemic outbreaks. While global evidence documents high rates of anxiety, depression, and burnout among HCWs, data from Thailand remain limited, particularly regarding temporal changes in mental health across outbreak phases. This study assessed the prevalence of anxiety, depression, and burnout among HCWs caring for COVID-19 patients at a Thai tertiary hospital and examined factors associated with these outcomes. Methods: A cross-sectional study was conducted between July and September 2020 at Rajavithi Hospital, Bangkok, Thailand. Healthcare workers (n=86) who provided direct care to confirmed COVID-19 patients were recruited using stratified random sampling. Participants retrospectively reported mental health symptoms during the peak outbreak period (January–April 2020) and completed assessments of current symptoms. Anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS), and burnout was assessed using the Maslach Burnout Inventory (MBI). Paired t-tests compared mental health scores between time periods, and multivariable logistic regression identified factors associated with depression, anxiety, and burnout. Results: Among 86 healthcare workers (mean age 35.2±8.4 years; 73.3% female; 44.2% nurses), mean anxiety scores were significantly higher during the peak outbreak compared with the post-outbreak period (8.2±4.1 vs. 6.5±3.8, p<0.001, Cohen’s d=0.43). The prevalence of clinically significant anxiety (HADS-A ≥8) decreased from 45.3% during the outbreak to 29.1% post-outbreak (p=0.012). Similarly, clinically significant depression (HADS-D ≥8) declined from 38.4% to 22.1% (p=0.008), with mean depression scores decreasing from 7.6±3.9 to 5.8±3.5 (p<0.001, Cohen’s d=0.48). Emotional exhaustion scores decreased from 24.8±12.3 during the outbreak to 19.7±11.5 post-outbreak (p<0.001), while depersonalization scores declined from 8.9±5.6 to 6.4±4.8 (p<0.001). However, 29.1% of participants continued to experience anxiety and 22.1% experienced depression after the outbreak subsided. In multivariable analysis, short sleep duration (<6 hours/night; adjusted OR=3.84, 95% CI: 1.52–9.71, p=0.004), use of sleeping medication (adjusted OR=4.21, 95% CI: 1.38–12.85, p=0.012), and caring for critically ill COVID-19 patients (adjusted OR=2.67, 95% CI: 1.08–6.59, p=0.033) were significantly associated with depression. Conclusions: Healthcare workers caring for COVID-19 patients experienced substantial psychological distress during the peak outbreak period, with nearly half reporting clinically significant anxiety and over one-third reporting depression. Although mental health indicators improved significantly after the outbreak subsided, persistent symptoms remained in approximately one-quarter to one-third of staff. Sleep disturbance, caring for critically ill patients, and working in high-intensity COVID-19 care settings emerged as key risk factors. These findings underscore the need for sustained organizational support, targeted mental health screening for high-risk groups, and evidence-based interventions to protect HCW wellbeing during and beyond public health emergencies.