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

Abstract. Experiencing severe flooding tends to negatively impact mental health, creating a significant public health issue. Moreover, extreme events can co-occur, magnifying potential impacts. Insights into the combined impact of co-occurring disasters on mental health, such as floods and COVID-19, are, however, largely lacking. We addressed this research gap by conducting 400 face-to-face interviews in October 2023 in Hue City, Vietnam, where residents faced simultaneous flooding and COVID-19 in 2020. The respondents' mental health was assessed using the Kessler psychological distress scale (K6), revealing that 20 % of the respondents experienced mental health distress, while 80 % did not report such 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 COVID-19 stressors. These five factors stay significant when combined. Additionally, a multivariable regression model revealed the combined effects of flood and COVID-19 when comparing the ORs of four groups ranging from “No flood stress and No Covid stress” to “Flood stress and Covid stress”. The effect size is largest for those who experienced flood and COVID-19 impacts, followed by those who suffered only floods and those who faced only COVID-19, with the smallest effect size. These findings underline the need to address public health problems caused by multiple risks, which is still a significant gap in developing countries. Furthermore, psychological impacts could be reduced by providing additional support to at-risk communities, like managing human remains, rehearsing evacuation plans, preventing school closures, and setting up public health infrastructure for psychological assistance.