Long-term mental health outcomes among healthcare workers following COVID-19 infection and frontline work: evidence of additive and non-additive patterns in Kazakhstan
- 1Department of Nursing, Al-Farabi Kazakh National University, Almaty, Kazakhstan
- 2Department of Health Policy and Organization, Al-Farabi Kazakh National University, Almaty, Kazakhstan
- 3High Medical College of the Almaty Public Health Department, Almaty, Kazakhstan
Abstract
Background: Long-term mental health outcomes of COVID-19 related exposures among healthcare workers remain poorly characterized, particularly in Central Asia.
Methods: We conducted a cross-sectional comparative study between June and August 2025 among 2715 healthcare workers. Participants completed validated measures of BAT-33, GAD-7, PHQ-9, and EQ-5D-5 L with EQ-VAS. Main and interaction effects were examined by two-way ANСOVA and associations were decomposed into direct and indirect components using path analysis with bootstrap confidence intervals.
Results: COVID-19 infection was associated with higher burnout, while the COVID × Red Zone interaction was not significant, indicating an additive pattern. In contrast, significant interactions were observed for anxiety, depression, and quality of life, suggesting higher psychological symptoms among workers with dual exposure. Red Zone work showed a statistically significant but small association with burnout. In mediation analyses, anxiety and depression statistically accounted for 39.7% of the variance in burnout (R2), suggesting these affective states are strongly associated associated with both pandemic-related exposures and burnout.
Conclusions: Pandemic-related occupational and personal exposures remained statistically associated with mental health outcomes among healthcare workers 3–5 years after COVID-19, with burnout showing an additive pattern and anxiety and depression showing non-additive deviations. Within our sample, the dual-exposed subgroup showed approximately 2-fold higher prevalence of clinically significant symptoms of anxiety and depression than unexposed colleagues. These findings identify a subgroup that may warrant continued monitoring in future longitudinal research with objective exposure verification, before specific clinical or policy recommendations can be advanced. This is among the first large-scale studies examining post-pandemic psychological outcomes among healthcare workers in Central Asia.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12889-026-28195-2.
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BibTeX
@article{ospanova2026longterm,
title = {{Long-term mental health outcomes among healthcare workers following COVID-19 infection and frontline work: evidence of additive and non-additive patterns in Kazakhstan}},
author = {Dinara Ospanova and Kundyzay Tobzhanova and Lyazzat Alibekova and Ainur Seitmanova and Galiya Bilibayeva and Zhanar Ibraimzhanova and Raushan Kurmankhanova and Ulbossyn Shokay and Roza Alekesheva and Meruyert Suleimenova},
journal = {BMC Public Health},
year = {2026},
month = jun,
doi = {10.1186/s12889-026-28195-2},
url = {https://doi.org/10.1186/s12889-026-28195-2},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Long-term mental health outcomes among healthcare workers following COVID-19 infection and frontline work: evidence of additive and non-additive patterns in Kazakhstan
AU - Dinara Ospanova
AU - Kundyzay Tobzhanova
AU - Lyazzat Alibekova
AU - Ainur Seitmanova
AU - Galiya Bilibayeva
AU - Zhanar Ibraimzhanova
AU - Raushan Kurmankhanova
AU - Ulbossyn Shokay
AU - Roza Alekesheva
AU - Meruyert Suleimenova
PY - 2026
DA - 2026/06/25
JO - BMC Public Health
DO - 10.1186/s12889-026-28195-2
UR - https://doi.org/10.1186/s12889-026-28195-2
AB - Background: Long-term mental health outcomes of COVID-19 related exposures among healthcare workers remain poorly characterized, particularly in Central Asia. Methods: We conducted a cross-sectional comparative study between June and August 2025 among 2715 healthcare workers. Participants completed validated measures of BAT-33, GAD-7, PHQ-9, and EQ-5D-5 L with EQ-VAS. Main and interaction effects were examined by two-way ANСOVA and associations were decomposed into direct and indirect components using path analysis with bootstrap confidence intervals. Results: COVID-19 infection was associated with higher burnout, while the COVID × Red Zone interaction was not significant, indicating an additive pattern. In contrast, significant interactions were observed for anxiety, depression, and quality of life, suggesting higher psychological symptoms among workers with dual exposure. Red Zone work showed a statistically significant but small association with burnout. In mediation analyses, anxiety and depression statistically accounted for 39.7% of the variance in burnout (R2), suggesting these affective states are strongly associated associated with both pandemic-related exposures and burnout. Conclusions: Pandemic-related occupational and personal exposures remained statistically associated with mental health outcomes among healthcare workers 3–5 years after COVID-19, with burnout showing an additive pattern and anxiety and depression showing non-additive deviations. Within our sample, the dual-exposed subgroup showed approximately 2-fold higher prevalence of clinically significant symptoms of anxiety and depression than unexposed colleagues. These findings identify a subgroup that may warrant continued monitoring in future longitudinal research with objective exposure verification, before specific clinical or policy recommendations can be advanced. This is among the first large-scale studies examining post-pandemic psychological outcomes among healthcare workers in Central Asia. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12889-026-28195-2.
SN - 1471-2458
ER -