SOCIAL WORK IN PUBLIC HEALTH

2021, VOL. 36, NO. 2, 142–149

https://doi.org/10.1080/19371918.2020.1871461

Anxiety among the Vietnamese Population during the COVID-19

Pandemic: Implications for Social Work Practice
Pham Tien Nam a, Nguyen Hanh Dung b, Nguyen Khac Liemc, Nguyen Tuan Hungd,
Dang KimKhanh Lye, and Hoang Van Minhf
a
Department of Social Work, Hanoi University of Public Health, Hanoi City, Vietnam; bGraduated Department,
University of Languages and International Studies, Vietnam National University, Hanoi City, Vietnam; cDepartment of
Medicine, Hanoi University of Public Health, Hanoi city, Vietnam; dDepartment of Personnel and Organisation, Ministry
of Health, Hanoi City, Vietnam; eDepartment of Social Work, University of Social Sciences and Humanities, Vietnam
National University, Hanoi City, Vietnam; fDepartment of Policy and Health Economics, Hanoi University of Public
Health, Hanoi city, Vietnam

ABSTRACT KEYWORDS
The COVID-19 pandemic is a global health crisis and threatening human lives, Anxiety; COVID-19
especially vulnerable groups. This study aimed to estimate the prevalence of pandemic; social work
self-reported anxiety and to examine associated factors among the practice; Vietnamese
Vietnamese population during the COVID-19 pandemic. A cross-sectional population; vulnerable
groups
study in Vietnam was conducted in April 2020. An online survey was used
to do the rapid assessment. Among 1,249 participants, the prevalence of self-
reported anxiety was 8.5%. In the multivariable regression models, significant
factors for self-reported anxiety were people aged 60 years old or older, rural
areas, and COVID-related music-video-watching. Implications for social work
practice were also discussed.

Introduction
The COVID-19 pandemic has impacted people in varying ways on an international scale (Lifeline
Australia, 2020). The World Health Organization has recognized COVID-19 as a global health
concern (Wang, Horby, Hayden, & Gao, 2020). As of April 19, 2020, the total number of people
diagnosed with COVID-19 was 2,241,778 cases globally, with 152,551 deaths in 213 countries, areas, or
territories (World Health Organization [WHO], 2020a). In public mental health terms, the main
psychological impact to date is elevated rates of stress or anxiety (WHO, 2020b). Therefore, the
psychological impact of the COVID-19 pandemic must be recognized alongside the physical symp­
toms in the general population, especially the vulnerable population (Zhou et al., 2020). An online
survey conducted in 31 provinces of Iran, with the participation of 10,754 individuals from the general
population during the COVID-19 pandemic, indicated that the total anxiety level was 8.61 ± 6.95 and
the severity of anxiety symptoms in 49.1% of cases was normal, in 9.3% was severe and in 9.8% was
very severe (Moghanibashi-Mansourieh, 2020).
In Vietnam, there have been a few studies on the COVID-19 pandemic that focus on the clinical
aspect (Thanh et al., 2020), and the public health aspect (Hoang Van Minh, 2020). To our knowledge,
this is the first study to investigate anxiety in the general population of Vietnam during the COVID-19
pandemic and to discuss its implications for social work practice. Besides health workers, social
workers also play an important role to fight the spread of the COVID-19 pandemic throughout the
world (International Federation of Social Workers [IFSW], 2020). In this study, we aimed to estimate
the prevalence of self-reported anxiety and to examine its associated factors among the Vietnamese

CONTACT Pham Tien Nam ptn1@huph.edu.vn Social Work Department, Hanoi University of Public Health, 1A Duc Thang
Road North Tu Liem District, Hanoi, Vietnam.
© 2021 Taylor & Francis Group, LLC
 SOCIAL WORK IN PUBLIC HEALTH 143

population during the COVID-19 pandemic. Moreover, we presented implications for social work
practice to confirm that the social work profession is responding to the COVID-19 pandemic.

Methods
Study design and study population
This was a cross-sectional study carried out in April 2020. A snowball sampling technique was used.
The study was an online survey conducted in 40 provinces/cities of Vietnam. The link to the
questionnaire was sent to participants through e-mails and Zalo. Zalo is the market-leading
messaging application from Vietnam, with more than 35 million active users. This application
can be easily accessed from both mobile and computer (Bogunovic, 2018). We asked the participants
to complete the questionnaire via a Google form and requested them to forward the link to others.
The sampling frame or the inclusion criteria for being in the study were: (1) being at least 18 years
old; (2) living in Vietnam during the survey period; (3) agreeing to participate in the study; and (4)
accessing to the internet to answer the questionnaire via a Google form. The final sample size was
1,249 participants.

Study variables and instruments

Our main dependent variable was anxiety status (yes; and no).
Independent variables included sociodemographic information. We divided age groups into three
categories (18–38 years old, 39–59 years old, and 60 years old or older), gender into two groups (male,
and female), marital status into two categories (single, and married), types of housemate into two
groups (living alone, and living with family or roommate), geographical regions into three categories
(Northern Vietnam, Central Vietnam, and Southern Vietnam), living area into two groups (urban
areas, and rural areas), occupational status into four categories (students, civil servants, freelancers,
retired people or housewives), and COVID-related music-video-watching in the last three months into
two groups (yes, and no). Housewives were grouped together with retired people in one category
because these two groups had a common feature of spending a majority of their time at home.
The study instruments included a questionnaire covering sociodemographic information and the
Generalized Anxiety Disorder Questionnaire (GAD-7) to screen for anxiety symptoms. The GAD-7 is
commonly used as a measure of general anxiety symptoms across various settings and populations
(Johnson, Ulvenes, Øktedalen, & Hoffart, 2019). The GAD-7 consists of seven questions. The scores
for these questions covered four outcomes: 0 “Not at all”, 1 “Several days”, 2 “More than half the days”,
and 3 “Nearly every day”. The total score ranged from 0 to 21. We applied the cutoff point method to
classify anxiety levels: none (0–4), mild (5–9), moderate (10–14), and severe (15–21). At the cutoff
point of 10, both sensitivity and specificity exceed 80% (Kroenke, Spitzer, Williams, Monahan, &
Löwe, 2007). In this study, respondents with a GAD-7 score of 10 or higher were classified as showing
anxiety symptoms.

Data analysis
To compare the differences in respondents’ anxiety symptoms, we used Chi-square by Stata 14.2
Survey package. Moreover, we examined the associated factors for self-reported anxiety by performing
the Multivariate Poisson regression model with robust error variances (Barros & Hirakata, 2003; Chen,
Qian, Shi, & Franklin, 2018; Zou, 2004). Prevalence Ratios (PRs) were calculated, together with
corresponding 95% Confidence Interval (CI), and we used a significance level of p < .05.
144 P.T.NAM ET AL.

Ethical considerations
Our study proposal was approved by the Institutional Review Board, the Vietnam Association of
Psychology. Study subjects were informed about the study objectives. Their responses would be
confidential, there would be no right or wrong answers, and they could stop or withdraw from
participation at any time.

Results
Sociodemographic characteristics of respondents
Sociodemographic characteristics are illustrated in Table 1. In a total of 1,249 respondents, 84.6%
watched COVID-related music videos. The majority of respondents were female (58.4%), aged
18–38 years old (53.2%), single (57.6%), living with family or roommate (78.5%). Among geographical
regions, Northern Vietnam accounted for the highest prevalence (50.8%). Nearly 40% of respondents
lived in rural areas (39.6%), but the majority (60.4%) lived in urban areas. Moreover, respondents had
different occupations such as university students (32.3%), civil servants (39.16%), freelancers (16.7%),
retired people or housewives (11.3%). In our study, 8.5% of the respondents reported anxiety symptoms.

Prevalence of respondents screened positive for anxiety symptoms

Table 2 shows the prevalence of respondents screened positive for anxiety symptoms. The prevalence
of older people, married status, and living in urban areas among respondents with self-reported
anxiety was higher than that of respondents without self-reported anxiety (74.5% vs 5.4%, 57.5% vs
41.0%, 76.4% vs 58.9%, p < .001, respectively). Respondents with self-reported anxiety accounted for
a high prevalence of retired people or housewives (61.3% vs 6.6%, p<.001). The prevalence of COVID-
related music-video-watching among respondents with self-reported anxiety was much lower than
that of those without self-reported anxiety (51.9% vs 87.7%, p<.001).

Table 1. Characteristics of respondents.

Variables Category Frequency %
Age groups 18–38 years old 664 (53.2%)
39–59 years old 444 (35.5%)
60 years old or older 141 (11.3%)
Gender Male 519 (41.6%)
Female 730 (58.4%)
Marital status Single 719 (57.6%)
Married 530 (42.4%)
Types of housemate Living alone 269 (21.5%)
Living with family or roommate 980 (78.5%)
Geographical regions Northern Vietnam 634 (50.8%)
Central Vietnam 299 (23.9%)
Southern Vietnam 316 (25.3%)
Living area Urban areas 754 (60.4%)
Rural areas 495 (39.6%)
Occupational status Students 404 (32.3%)
Civil servants 495 (39.6%)
Freelancers 209 (16.7%)
Retired people or housewives 141 (11.3%)
COVID-related music-video-watching No 192 (15.4%)
Yes 1057 (84.6%)
Self-reported anxiety No 1143 (91.5%)
Yes 106 (8.5%)
N = 1249
 SOCIAL WORK IN PUBLIC HEALTH 145

Table 2. Anxiety of respondents.

Columns by:
Self-reported anxiety No Yes Total P-value
1143 106 1249
Age groups, n (%) <0.001
18–38 years old, n (%) 651 (57.0%) 13 (12.3%) 664
39–59 years old, n (%) 430 (37.6%) 14 (13.2%) 444
60 years old or older, n (%) 62 (5.4%) 79 (74.5%) 141
Gender, n (%) 0.007
Male, n (%) 488 (42.7%) 31 (29.2%) 519
Female, n (%) 655 (57.3%) 75 (70.8%) 730
Marital status, n (%) <0.001
Single, n (%) 674 (59.0%) 45 (42.5%) 719
Married, n (%) 469 (41.0%) 61 (57.5%) 530
Types of housemate, n (%) 0.15
Living alone, n (%) 252 (22.0%) 17 (16.0%) 269
Living with family or roommate, n (%) 891 (78.0%) 89 (84.0%) 980
Geographical regions, n (%) 0.88
Northern Vietnam, n (%) 582 (50.9%) 52 (49.1%) 634
Central Vietnam, n (%) 274 (24.0%) 25 (23.6%) 299
Southern Vietnam, n (%) 287 (25.1%) 29 (27.4%) 316
Living area, n (%) <0.001
Urban areas, n (%) 673 (58.9%) 81 (76.4%) 754
Rural areas, n (%) 470 (41.1%) 25 (23.6%) 495
Current occupation, n (%) <0.001
University students, n (%) 394 (34.5%) 10 (9.4%) 404
Civil servants, n (%) 482 (42.2%) 13 (12.3%) 495
Freelancers, n (%) 191 (16.7%) 18 (17.0%) 209
Retired people or housewives, n (%) 76 (6.6%) 65 (61.3%) 141
COVID-related music-video-watching, n (%)
No, n (%) 141 (12.3%) 51 (48.1%) 192 <0.001
Yes, n (%) 1002 (87.7%) 55 (51.9%) 1057
Statistical comparison using
Chi-square test for categorical variable – display as n(%);
The bold p-value indicated statistical significance (p < 0.05).

Factors associated with self-reported anxiety

Table 3 presents factors associated with self-reported anxiety. In the multivariate regression model,
associated factors that affected the prevalence of self-reported anxiety included age groups, living
areas, and COVID-related music-video-watching. In terms of age groups, the prevalence of self-
reported anxiety among respondents aged 60 years old or older was 19.18 times higher than that of
respondents aged 18–38 years old (PR = 19.18, 95% CI: 8.93–41.17). The prevalence of self-reported
anxiety among respondents living in rural areas was less than that of respondents living in urban areas
(PR = 0.67, 95% CI: 0.48–0.94). COVID-related music-video-watching significantly reduced the
prevalence of self-reported anxiety (PR = 0.31, 95% CI: 0.22–0.44).

Discussion
Our results show that the prevalence of self-reported anxiety among the Vietnamese population was
8.5%. This prevalence was lower in a study in China from January 31 to February 2, 2020 (22.6%) (Gao
et al., 2020). The COVID-19 pandemic was rapidly transmitted in China compared to Vietnam. It
threatens people’s physical health and triggers a wide variety of psychological problems such as
anxiety, fear, depression, and insomnia (Gao et al., 2020; Li et al., 2020). Vietnam has achieved
some successes in reducing the spread of COVID-19 in the country due to the direction of the
Vietnamese government, and proactive and comprehensive community health actions (Hoang Van
Minh, 2020). As of April 19, 2020, 268 cases of COVID-19 have been confirmed (no case of death) in
Vietnam (Ministry of Health, 2020). Therefore, the prevalence of self-reported anxiety among the
146 P.T.NAM ET AL.

Table 3. Factors associated with anxiety.

Model
PR 95% CI
Age groups
18–38 years old REF .
39–59 years old 1.57 0.63– 3.90
60 years old or older 19.18 8.93– 41.17 ***
Gender
Male REF .
Female 1.09 0.73– 1.64
Marital status
Single REF .
Married 0.75 0.55– 1.04
Types of housemate
Living alone REF .
Living with family or roommate 1.54 0.86– 2.77
Living area
Urban areas REF .
Rural areas 0.67 0.48– 0.94 *
Occupational status
University students REF .
Civil servants 1.20 0.56– 2.56
Freelancers 1.54 0.75– 3.14
Retired people or housewives 1.46 0.80– 2.66
COVID-related music-video-watching
No REF .
Yes 0.31 0.22– 0.44 ***
N = 1249
* p < .05 – ** p < .01 – *** p < .001

Vietnamese population was lower than that of other countries such as China, and Iran (Gao et al.,
2020; Moghanibashi-Mansourieh, 2020).
Our regression models found that age groups were associated with self-reported anxiety. The
prevalence of self-reported anxiety among people aged 60 years old or older was higher than that of
other age groups. Older adults, who have chronic medical conditions including heart disease, lung
disease, diabetes, cancer, and hypertension are at higher risk for more serious COVID-19 illness and
death (National Foundation for Infectious Diseases, 2020; World Health Organization, 2020).
Moreover, social isolation is a serious public health concern and is known to increase the risk of
adverse mental health outcomes among older adults (Gerst-Emerson & Jayawardhana, 2015).
We demonstrated a relationship between the living area and self-reported anxiety. The prevalence of
self-reported anxiety among people living in rural areas was lower than that of people living in urban
areas. In Vietnam, the majority of confirmed COVID-19 cases were in urban areas such as Hanoi, and
Hochiminh city (Ministry of Health, 2020). People living in urban areas could be worried about
COVID-19 infection, business interruption, school closure, and social distancing (La et al., 2020).
Data from this study also show an association between COVID-related music-video-watching and
self-reported anxiety. The prevalence of self-reported anxiety among people who watch COVID-
related music video was lower than that of people who do not watch COVID-related music video. The
music video has become an important part of health education to raise the awareness and behavior of
viewers (Brame, 2016; Kopf, Graetzer, & Huh, 2015). Furthermore, the music video also leads to the
psychological comfort of viewers (Hutchinson, Karageorghis, & Jones, 2015). Among COVID-related
music videos in Vietnam, “Ghen Cô Vy” (English: Jealous Coronavirus) was produced by the Vietnam
Ministry of Health and released in an attempt to fight against the COVID-19 pandemic. This is also
a means to promote preventive measures such as washing hands, not touching one’s face, and keeping
their surroundings clean (Vietnamnet, 2020). Viewers would feel more comfortable and highly
 SOCIAL WORK IN PUBLIC HEALTH 147

enthusiastic when watching this music video with its accompanying dance “Vũ điệu rửa tay” (English:
Handwashing Dance) (Tuoitre, 2020).

Conclusions and implications for social work practice

Our study found that the prevalence of self-reported anxiety among the Vietnamese population during
the COVID-19 pandemic was lower than found in previous studies in other countries. The significant
associated factors of self-reported anxiety among the Vietnamese population were people aged
60 years old or older, rural areas, and COVID-related music-video-watching.
The World Health Organization is also concerned about mental health problems and psycho-social
consequences during the COVID-19 pandemic (WHO, 2020c). Different target groups such as children,
older adults, people in isolation, and healthcare workers are at high risk of mental health problems
during the COVID-19 pandemic (WHO, 2020c). People who are employed in the informal and
unorganized sectors are the worst hit. This group may have difficulty in many aspects of life such as
food, shelter, etc. Their livelihood may lead to mental health problems such as stress, anxiety, and
depression (Kumar & Rajasekharan Nayar, 2020). Additionally, refugees and persons displaced by armed
conflict and disaster are in need of psychological support during the COVID-19 pandemic (Community
and Family Services International [CFSI], 2020). The vulnerable groups in the community must receive
psychosocial supports from social workers to reduce anxiety during the COVID-19 pandemic (Kumar &
Rajasekharan Nayar, 2020; National Association of Social Workers [NASW], 2020).
Our results also reported the relationship between the prevalence of self-reported anxiety and asso­
ciated factors among the Vietnamese population. Therefore, social workers need to pay more attention to
the vulnerable groups as well as the associated factors in our study. We could recommend that social
workers address the anxiety aspect of the COVID-19 pandemic as follows: (1) reach out to vulnerable
groups affected by the COVID-19 pandemic to collect feedback and capture the needs of the vulnerable
groups through community-based surveys or phone calls (Inter-agency Standing Committee [IASC],
2020); (2) provide online counseling services for people (Liu et al., 2020). It is necessary to pay attention to
the development of smartphone applications and detailed usage instructions. This is the most accessible
online channel for all target groups, including the rural population which may lack access to technology;
(3) to create a health awareness campaign for vulnerable groups via various channels, especially social
media to fight against the COVID-19 pandemic such as how to manage stress and anxiety, how to stay safe
and healthy at home, how to talk about COVID-19 with children, etc. (IASC, 2020).
Implications for social work practice in our study could be useful for policymakers, researchers, and
social work practitioners in the world. Policymakers concerned with social work need to pay attention
to the vulnerable groups and associated factors. Suitable policies are essential to ease vulnerable
groups’ anxiety. Researchers should explore more associated factors from our findings. We hope
that there will be more evidence-based studies, especially on the effect of social work’s intervention on
the mental health problems of the vulnerable groups during the COVID-19 pandemic (Purgato et al.,
2018). Besides, the provision of social work services in person or through technology depends on the
national regulations and the levels of COVID-19 infection (Allan Barsky, 2020). Agencies and social
workers may consider the NASW Code of Ethics for social work practice during the COVID-19
pandemic. The NASW Code of Ethics includes values, principles, and standards to guide social
workers’ conduct. They are relevant to the professional activities of social workers in different social
work fields of practice (NASW, 2017).

Acknowledgments
The authors thank people who participated in this study for their support of the study.
148 P.T.NAM ET AL.

Disclosure statement
No potential conflict of interest was reported by the authors.

Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID
Pham Tien Nam http://orcid.org/0000-0002-0613-2173
Nguyen Hanh Dung http://orcid.org/0000-0002-7694-664X

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