Psychological distress among healthcare workers in Kabul following the 2021 transition

Abstract

Background: Healthcare workers (HCWs) in conflict and post-conflict settings are particularly susceptible to psychological distress due to persistent occupational stress and limited systemic support. This study examined the prevalence of psychological distress among HCWs in Kabul, Afghanistan, in the wake of the political changes in August 2021. Methods: A cross-sectional survey study was conducted from September to October 2021 in 16 public tertiary hospitals in Kabul. The Afghan Symptoms Checklist (ASCL) was used to assess psychological distress and its related symptoms. Multivariable analysis using Generalized Linear Model (GLM) was performed to find the associated factors of psychological distress utilizing STATA 18. Results: A total of 277 HCWs participated in the study, with 48.4% identifying as female. Approximately 62% had considered leaving Afghanistan, and 64% had witnessed colleagues emigrate. The overall prevalence of psychological distress was 25% (CI 95%: 19.9–30.6), with stress-induced reactivity as the most prevalent symptom (35%, CI 95%: 29.8–41.4). Female HCWs were significantly more likely to report sadness with social withdrawal and somatic distress (POR = 2.32, CI 95%: 1.07–5.02, p = 0.03) and stress-induced reactivity (POR = 2.56, CI 95%: 1.22–5.44, p = 0.013). A lack of optimism about the future was associated with higher odds of stress-induced reactivity (POR = 3.14, CI 95%: 1.55–6.38, p = 0.001), ruminative sadness without withdrawal (POR = 3.05, CI 95%: 1.68–6.24, p = 0.002), and sadness with withdrawal and somatic distress (POR = 3.73, CI 95%: 1.71–8.13, p = 0.001). Conclusion: One in four HCWs reported psychological distress, with stress-induced reactivity being the most common symptom. Female gender and pessimism about the future were key associated factors of elevated distress. The findings highlight the critical need for long-term mental health support programs specifically designed for HCWs, broader support within the health system, and continued research into how HCWs cope and build resilience.