Mental Health and Non Communicable Diseases (NCDs)

Mental Health and NCDs are health issues that have received a lot of attention in recent years. ICHR Institute has leading experts in these fields in the Central - Central Highlands region, participating in research on mental health in vulnerable subjects such as postpartum women, the elderly... Besides, there are time-appropriate studies such as stress in health care workers during the COVID-19 pandemic.Below are abstracts of the ICHR Institute's recent studies, with the names in bold being the members of the ICHR Institute.The full text can be found in the Institute's International publications directory.

1. Stress and Associated Factors among Frontline Healthcare Workers in the COVID-19 Epicenter of Da Nang City, Vietnam

Nhan Nguyen, Duong Dinh Le, Robert Colebunders, Joseph Nelson Siewe Fodjo, Trung Dinh Tran, Thang Van Vo

Frontline healthcare workers (HCWs) involved in the COVID-19 response have a higher risk of experiencing psychosocial distress amidst the pandemic. Between July and September 2020, a second wave of the COVID-19 pandemic appeared in Vietnam with Da Nang city being the epicenter. During the outbreak, HCWs were quarantined within the health facilities in a bid to limit the spread of COVID-19 to their respective communities. Using the stress component of the 21-item Depression, Anxiety and Stress Scale (DASS-21), we assessed the level of stress among HCWs in Da Nang city. Between 30 August and 15 September 2020, 746 frontline HCWs were recruited to fill in an online structured questionnaire. Overall, 44.6% of participants experienced increased stress and 18.9% severe or extremely severe stress. In multivariable analysis, increased stress was associated with longer working hours (OR = 1.012; 95% CI: 1.004-1.019), working in health facilities providing COVID-19 treatment (OR = 1.58, 95% CI: 1.04-2.39), having direct contact with patients or their bio-samples (physicians, nurses and laboratory workers; OR = 1.42, 95% CI: 1.02-1.99), low confidence in the available personal protective equipment (OR = 0.846; 95% CI: 0.744-0.962) and low knowledge on COVID-19 prevention and treatment (OR = 0.853; 95% CI: 0.739-0.986). In conclusion, many frontline HCWs experienced increased stress during the COVID-19 outbreak in Da Nang city. Reducing working time, providing essential personal protective equipment and enhancing the knowledge on COVID-19 will help to reduce this stress. Moreover, extra support is needed for HCWs who are directly exposed to COVID-19 patients.

In the context of the COVID-19 epidemic, the ICHR Institute has cooperated with the University of Antwerpt, Belgium under the coordination of Prof. Robert Colebunders in the International Citizen Project COVID-19. As a result, studies on stress in health care workers in the context of a pandemic have been published. (Photo source here)

The ICHR Institute study on stress among frontline healthcare workers during the COVID-19 pandemic is one of the first in its field. (photo source: Vietnam ministry of Health)

2. Well-Being of Healthcare Workers and the General Public during the COVID-19 Pandemic in Vietnam: An Online Survey

Tuyen Dinh Hoang, Robert Colebunders, Joseph Nelson Siewe Fodjo, Nhan Phuc Thanh Nguyen, Trung Dinh Tran, Thang Van Vo

The COVID-19 pandemic and associated restrictive measures implemented may considerably affect people's lives. This study aimed to assess the well-being of Vietnamese people after COVID-19 lockdown measures were lifted and life gradually returned to normal. An online survey was organized from 21 to 25 April 2020 among Vietnamese residents aged 18 and over. The survey was launched by the Hue University of Medicine and Pharmacy. The WHO-5 Well-Being Index (scored 0-25) was used to score participants' well-being. A multivariate logistic regression model was used to determine the predictors of well-being. A total of 1922 responses were analyzed (mean age: 31 years; 30.5% male; 88.2% health professionals or students in the health sector). The mean well-being score was 17.35 ± 4.97. Determinants of a high well-being score (≥13) included older age, eating healthy food, practicing physical exercise, working from home, and adhering to the COVID-19 preventive measures. Female participants, persons worried about their relatives' health, and smokers were more likely to have a low well-being score. In conclusion, after the lockdown measures were lifted, the Vietnamese have people continued to follow COVID-19 preventive measures, and most of them scored high on the well-being scale. Waiting to achieve large-scale COVID-19 vaccine coverage, promoting preventive COVID-19 measures remains important, together with strategies to guarantee the well-being of the Vietnamese people.

3. Brief screening for maternal mental health in Vietnam: Measures of positive wellbeing and perceived stress predict prenatal and postnatal depression

Huyen PhucDo, Philip RA Bakera, Thang VanVo, Bao-YenLuong-Thanh, Lan Hoang Nguyen, Sara Valdebenitoe, ManuelEisnere, Bach XuanTran, Tuyen Dinh Hoang, Michael P Dunne

Background: In many countries, there is limited consideration of the psychological wellbeing of women during antenatal and postnatal care. Among a range of contributing factors, one practical reason is that brief, valid and reliable screening tools are not widely used to guide clinical interviews. The present study evaluated psychometric properties of three brief scales that measure recent wellbeing (the WHO-5 index), perceived stress (the PSS-10) and depression (the PHQ-9).

Methods: A prospective birth cohort study was completed in Hue City, central Vietnam with 148 pregnant women in the third trimester of pregnancy, with follow-up 3–5 months after childbirth. Moderate-to-severe antenatal depressive symptoms were used as the reference standard to validate the WHO-5 and PSS-10.

Results: Approximately one-third of the women indicated significant stress and 12% reported moderate to severe depressive symptoms during pregnancy. The WHO-5 and PSS had good internal consistency (Cronbach's alpha=0.76–0.81) and good discriminant properties against prenatal depression. Area Under the Curve (AUC) values showed good predictive validity to detect postpartum depressive symptoms for the WHO-5 [AUC=0.73, 95% CI (0.60 – 0.86)] and the PSS-10 [AUC=0.69, 95% CI (0.45 – 0.92)]. WHO-5 scores ≤ 60/100 and PSS-10 scores ≥ 20/40 provided good sensitivity (approx.83%) and fair specificity (approx.61%) to detect depression pre- and post-natally.

Conclusions: Given these satisfactory psychometric properties, brief but broad screening that includes questions about positive wellbeing and recent stress in addition to depressive symptoms should be integrated into routine psychosocial care for pregnant women in Vietnam and similar cultural contexts.

4. Do Communication Patterns Affect the Association between Cognitive Impairment and Hearing Loss among Older Adults in Vietnam?

Tran Dai Tri Han, Keiko Nakamura, Kaoruko Seino, Vo Nu Hong Duc, Thang Van Vo

This study examined the prevalence of cognitive impairment among older adults in central Vietnam and the roles of communication (with or without communication devices) in the association between cognitive impairment and hearing loss. This cross-sectional study was performed on 725 randomly selected community-dwelling older adults aged ≥60 years from Thua Thien Hue province, Vietnam. Participants attended a face-to-face survey. Sociodemographic characteristics, social interaction with or without communication devices, health status and cognitive function using the Mini-Mental State Examination were reported. Ordinal logistic regression analysis was performed to quantify the association between hearing loss and cognitive function by frequency of communication with and without devices. Mild and severe cognitive impairment had prevalence rates of 23.6% and 19.3%, respectively. Cognitive impairment was more prevalent among older adults with hearing-loss, vision loss and difficulties with instrumental activities of daily living (IADL). The association between hearing loss and cognitive impairment was not significant when older adults had frequent communication with others using devices. This study presented the relatively high prevalence of cognitive impairment in community-dwelling older adults in Vietnam. Frequent communication using devices attenuated the association between hearing loss and cognitive impairment.

Mr. Hoang Dinh Tuyen - data collector of "The Project on Workforce Development for Elderly Healthcare in ASEAN Countries". This is a collaborative study between Tokyo Medical and Dental University and ICHR.

5. Fear of falling and cognitive impairment in elderly with different social support levels: findings from a community survey in Central Vietnam

Thi Hue Man Vo, Keiko Nakamura, Kaoruko Seino, Hoang Thuy Linh Nguyen, Thang Van Vo

Background: Fear of falling (FoF) in the elderly is one of the major public health concerns in this era of aging of the population. As there is limited evidence on how cognitive function may differ by social support level in relation to FoF among the elderly, this cross-sectional study aims to investigate the prevalence of FoF and the associations between cognitive impairment and FoF by the social support level, after adjustments for potential confounders. Methods: Data from the “Health needs assessment of elderly in Thua Thien Hue Province, Vietnam in 2018” survey of 725 elderly aged 60 years or older were used for analysis. FoF was assessed using the Fall Efficacy ScaleInternational. High FoF was defined as a score above 28. The Multidimensional Scale of Perceived Social Support was used to measure the perception of support. Logistic regression analysis was performed to investigate the association between cognitive function and FoF by social support levels (p < 0.05). Results: The prevalence of high FoF among the elderly was 40.8%. Female gender, advanced age, a marital status of single or formerly married, living alone, history of injury, history of falls, chronic diseases (arthritis and/or hypertension), limitations of the IADL and BADL, visual difficulty and walking difficulty, low social support, and cognitive impairment were all significantly associated with a high FoF. After adjustments for the age, gender, marital status, history of falls and health-related factors, cognitive impairment remained significantly associated with a high FoF among the elderly with a low to moderate social support level (OR = 2.97, 95% CI 1.49–5.89), but not in those with a high social support level. Conclusions: A high FoF was associated with impairment of cognitive function among the elderly who perceived themselves as having low or moderate support levels, even after adjustments for socio demographic and physical functional factors. However, this association was not observed among the elderly who perceived themselves as having high social support levels. Fall prevention programs for the elderly with various levels of social support should be carefully devised, keeping in mind the cognitive function levels of the target recipients.

6. Mental health problems both precede and follow bullying among adolescents and the effects differ by gender: a cross-lagged panel analysis of school-based longitudinal data in Vietnam

Ha Thi Hai Le, Nam Tran, Marilyn A. Campbell, Michelle L. Gatton, Huong Thanh Nguyen and Michael P. Dunne

Background: The signifcant psychosocial harms from bullying among adolescents create major challenges for mental health promotion programs and services in schools. While the negative consequences of bullying victimisation are well known, to date there is scarce empirical analysis of inverse associations, in which mental health problems make children more vulnerable to bullying victimisation and perpetration. Based on a short-term longitudinal study among adolescents in Vietnam, this study examined reciprocal associations between children’s depressive symptoms, psychological distress, suicidal ideation and bullying victimisation experiences (i.e., victims or bully-victims). Methods: Secondary and high school students (n=1167; age range: 11–16 years old; 55% female) in urban areas in northern Vietnam completed two self-administered questionnaires, 6-months apart in the academic year 2014–2015. Measures estimated bullying victimisation and perpetration in the past 6 months, depressive symptoms, psychological distress, and suicidal ideation. A cross-lagged analysis was performed to test the reciprocal associations. Results: About one-third of students in the sample were involved as victims, bullies or bully-victims at both times, with more males than females reporting these experiences. Females reported a higher level of depressive symptoms than males at Time 1 but not at Time 2. After adjusting for outcome variables and other covariates measured at Time 1, nine of 12 cross-lagged associations across three models were statistically signifcant, with diferent patterns for females and males. There were reciprocal associations between bullying victimisation and mental health problems. Bullying victimisation was shown as an independent predictor of subsequent mental health problems; in turn, mental health problems preceded students’ experience of becoming victims or bully-victims. Females with mental health problems were more likely to be victims; whereas similarly distressed males were vulnerable to both being bullied and being perpetrators. Conclusion: This study is the frst of its kind in Vietnam and in the Southeast Asian region to examine reciprocal associations between bullying victimisation and mental health problems among adolescents. Anti-bullying intervention and prevention programs and school-based mental health promotion programs should be integrated and be sensitive to gender diferences in order to maximise their impact.

7. Associated Factors of Hypertension in Women and Men in Vietnam: A Cross-Sectional Study

Tran Quoc Cuong, Le Van Bao, Nguyen Anh Tuan, Vo Van Thang, Nguyen Minh Quan, Shwu-Huey Yang and Tuyen Van Duong

Background: Hypertension is a direct cardiovascular disease risk. It causes a heavy burden on the healthcare system globally. We aim to assess hypertension occurrence and its associated factors among women and men in Vietnam.

Methods: A cross-sectional study was conducted from January to February 2019 on 2203 community-dwelling women and men aged 18 years or above. Participants' characteristics, comorbidity, behaviors, and physical measures were evaluated. Hypertension was classified as systolic/diastolic blood pressure ≥140/90 mmHg or using antihypertensive medication. We analyzed data using logistic regression models.

Results: The prevalence of hypertension was 24.3% (20.9% in women, 29.1% in men). For women, older age (odds ratio, OR, 6.80-12.41; p < 0.001), income above the poverty line (OR, 0.64; p = 0.008), diabetes comorbid (OR, 2.98; p < 0.001), added salts consumption (OR, 1.80; p < 0.001), overweight/obesity (OR, 1.64; p = 0.005), abdominal obesity (OR, 2.07; p < 0.001) were associated with hypertension. For men, older age (OR, 2.67-5.92; p < 0.001), diabetes comorbid (OR, 2.25; p = 0.010), smoking (OR, 1.38; p = 0.046), and overweight/obesity (OR, 2.18; p < 0.001) were associated with hypertension. Conclusions: Hypertension is prevalent in Vietnamese people. The associated factors of hypertension are varied by gender.

Trang Thi Hanh Do - PhD student from Queensland University of Technology (QUT), Australia that conducted project related to depression, anxiety, post-traumatic stress and influencing factors in people in Central Vietnam. The ICHR Institute provided technical advice, assistance in organization and data collection.

8. Trauma Exposure and Mental Health Problems Among Adults in Central Vietnam: A Randomized Cross-Sectional Survey

Trang Thi Hanh Do, Ignacio Correa-Velez and Michael P. Dunne

Background: There is relatively little evidence about the psychological and social impacts of trauma exposure in the general population in East Asian countries. Vietnam has a long history of war and poverty, is prone to natural disasters and has high mortality related to traffic accidents. The mental health systems may be inadequate to cope with the resultant trauma.

Objectives: This research examines the lifetime prevalence of single and multiple traumas and the association between trauma exposure and depression, anxiety and post-traumatic stress disorder (PTSD) among a randomly selected sample of the adult population in Thua Thien-Hue province in central Vietnam.

Methods: Six hundred and eight Vietnamese adults aged 18 years or older participated in the survey. The main tools in the face-to-face interview included the Life Event Checklist (LEC) to measure trauma exposure, the Hospital Anxiety and Depression Scale (HADS) and the PTSD Checklist for DSM-IV (PCL-IV). Hierarchical multiple logistic regression was used to examine associations between trauma exposure and mental health.

Results: Forty seven percent of the participants experienced at least one traumatic event in their lifetime and about half of these people were exposed to multiple traumas. The prevalence of depression, anxiety, and PTSD symptoms among the total sample was 12.7, 15.5, and 6.9%, respectively. Prevalence of PTSD among those reporting trauma exposure was 14.8%. Exposure to a higher number of trauma types was associated with increased risk of having depression, anxiety, and PTSD symptoms. Interpersonal traumas were strongly associated with symptoms of all three mental disorders while non-interpersonal traumas were only associated with depressive symptoms.

Conclusion: Our findings indicate high burden of lifetime trauma and mental ill health in the adult population of central Vietnam and show a cumulative effect of multiple traumas on symptoms of the three mental disorders. Interpersonal trauma appears to have a more harmful effect on mental health than non-interpersonal trauma. Efforts to improve mental health in Vietnam should focus on reducing risk of preventable interpersonal trauma in every stage of life, and more broadly, ensure greater availability of trauma-sensitive mental health programs and services.

Seiji Humphries - PhD student from QUT university, Australia (rightmost) and Dr. Binh Thang - ICHR's research assistant during data collection in mountainous area of Seiji Humphries. His project (Measuring recovery from psychotic illness in central Vietnam) is inspired by surprising previous research indicating that recovery from psychotic illnesses such as schizophrenia may be better in some developing countries when compared with the developed world. There have been very few previous studies on this topic in Vietnam so Seiji hopes that his research will contribute to the understanding of these serious mental disorders, both in this country and more widely. 

Dr. Huong - lecturer from Faculty of Public Health, Hue University of Medicine and Pharmacy participated into data collection of Seiji Humphries's project.

9. Early psychosis in central Vietnam: A longitudinal study of short-term functional outcomes and their predictors

Seiji Humphries, Robert King, Michael P Dunne and Cat Huu Nguyen

Background: Few longitudinal studies have investigated the functional outcomes of individuals with recent-onset psychotic illness in low- and middle-income countries.

Aims: To investigate short-term functional remission and its predictors in a central Vietnamese sample.

Methods: A naturalistic 6-month prospective cohort study recruited 79 patients of public health facilities who had experienced a first episode of schizophrenia or related illness in the past 18 months. Individuals and their family members were interviewed using standardised assessments of community functioning, symptoms, treatment, demographics and various psychosocial variables. Rates of functional remission (i.e. no or minimal impairment) were calculated based on rigorous, culturally appropriate criteria. Generalised estimating equations were used to explore predictors of remission.

Results: Rates of global functional remission were 28% at baseline and 53% at follow-up. In individual functional domains, remission was least common for occupational activities, intermediate for relationships and relatively common for daily living activities. Global functional remission was significantly associated with absence of negative and cognitive symptoms, average or better household economic status and unimpaired premorbid functioning.

Conclusion: Remission rates appeared similar to those seen in many international intervention studies. However, individuals from poor households had markedly unfavourable outcomes, suggesting the need for community-based interventions targeting low-socioeconomic status (SES) groups.

ICHR Institute is pleased to be one of the representatives of Vietnam participating in the project "Strengthening of NCDs surveillane system" among 6 ASEAN countries

10. Perceptions of Mental Health and Help-Seeking Behavior in an Urban Community in Vietnam: An Explorative Study

L. van der Ham, P. Wright, T. V. Van, V. D. Doan, J. E. Broerse

Abstract This explorative study assesses perceptions of mental health and help-seeking behavior among adults in Vietnam. Methods included questionnaires (200) and focus group discussions (eight). Respondents were often unable to name specific mental illnesses. Frequently mentioned symptoms of mental illness were talking nonsense, talking/ laughing alone and wandering. Pressure/stress and studying/thinking too much were often identified causes. Most respondents showed a preference for medical treatment options, often in combination with family care. The results show that perceptions of mental health and help-seeking behaviour are influenced by a lack of knowledge and a mix of traditional and modern views. Keywords Mental health Mental illness Perceptions Help-seeking behavior