Understanding the combined mental health impacts of flooding and COVID-19 in Hue City, Central Vietnam

Experiencing severe flooding tends to worsen mental health, e.g., increased incidence of anxiety, depression, or post-traumatic stress disorder, creating a significant public health issue to be addressed. Moreover, extreme events can co-occur, magnifying potential impacts. For example, in 2020, several countries suffered severe floods, including Vietnam, simultaneously with the COVID-19 pandemic. Understanding the combined mental health impacts of floods and COVID-19 is an existing research gap we seek to address by conducting 400 face-to-face surveys in October 2023 in two coastal communes in Hue City, where local people faced widespread severe flooding, COVID-19 restrictions and lockdowns.

The respondents' mental health was assessed using the Kessler psychological distress scale (K6). Results show that 20% of the respondents report they have mental health distress, and 80% report no mental health distress. Binary logistic regression models demonstrated that among twelve flood stressors, facing ‘livelihood difficulties’, ‘seeing dead human bodies’, and ‘being rescued’ relate significantly to mental distress. Meanwhile, ‘impacts on individual health’ and ‘interrupted education’ are the two significant stressors of COVID-19. When combined, these five factors stay significant, with ‘seeing dead human bodies’ and ‘interrupted education’ increasing their odds ratios (ORs), while the ORs of the other factors decreased. Additionally, the multivariable regression model revealed the combined effects of flood and COVID-19 when comparing the ORs of four groups ranging from ‘No flood stress & No Covid stress’ to ‘Flood stress & Covid stress’. Effect size is highest for those who experienced both flood and COVID-19 impacts in the same year with OR = 9.67 (p-value < 0.001), compared with those who suffered only flood impacts with OR = 5.47 (p-value < 0.001), or only COVID-19 impacts with OR =2.83 (p-value < 0.1).

These findings are insightful for addressing public health problems under the impacts of multiple risks instead of focusing on a single risk. This draws attention to systematic mental health assessment and care for vulnerable groups, which is still a significant gap in developing countries. Also, the results raise the need for supporting policies and action plans to reduce the psychological impacts of the coincidences of disasters and pandemics, like providing additional support to at-risk communities. Specifically, some interventions or solutions during and after disasters, like the management of human remains, rehearsed evacuation plans, prevention of school closure, and setting up public health infrastructure for psychological assistance, are needed.