Anxiety, depression, and their associations with COVID-19-related knowledge, attitudes, and practices among healthcare professionals: a multinational cross-sectional survey

Objective: To investigate the levels of anxiety and depression (A&D) and the association with knowledge, attitudes, and practices among healthcare professionals (HCPs) in Taiwan, Indonesia, and Vietnam. Methods: A multinational cross-sectional survey was performed to collect data from 3,556 HCPs through online platforms. The Likert scale questionnaire covered sociodemographic factors, work-related information, and COVID-19-related domains, including knowledge, attitudes, practices, working conditions and availability of personal protective equipment, changes in work and life routines due to the COVID-19 pandemic, and experiences of A&D. Multiple logistic regression models were used to evaluate the potential impact of the aforementioned domains on the levels of A&D across and between countries. Results: Distinct A&D profiles emerged among the three countries. Taiwan exhibited higher A&D scores (average 2.31) than Vietnam (1.61) and Indonesia (1.93) (p < 0.001). Taiwan also showed elevated knowledge and attitudes scores. Consistent patterns were observed in responses on practices, working conditions, and pandemic impact on daily routines. Multivariate analysis showed that higher knowledge and attitudes scores were significantly associated with reduced A&D risk in Taiwan. Experiencing the greatest changes in work and daily routines was strongly linked to higher A&D risk, with adjusted odds ratios of 3.64 (95% CI: 1.41–9.45) in Indonesia, 4.13 (95% CI: 2.96–5.75) in Taiwan, and 5.14 (95% CI: 3.18–8.31) in Vietnam. Further analysis revealed that factors such as transportation, work dynamics, family time, dietary habits, and income level, but not leisure time, had varying impacts on A&D across the three countries. Conclusion: A&D and COVID-19-related knowledge, attitudes, and practices vary across countries. Thus, personalized support mechanisms and interventions are needed to address the diverse needs of HCPs within specific policy and country contexts.