DOI: https://doi.org/10.26758/14.1.12
(1), (3) Hue University, Hue University of Sciences, Faculty of Sociology and Social Work, Vietnam; E-mail: (1) phamtiensy@hueuni.edu.vn (3) phuongnguyens244@gmail.com (corresponding author); (2) Thanh Hoa University of Culture, Sports and Tourism; Email: kimdungkls@gmail.com
Address correspondence to: Thi Hoai Phuong NGUYEN, Hue University, Hue University of Sciences, Faculty of Sociology and Social Work, Thua Thien Hue, 53000, Vietnam. Ph.: 0084-946-408-889; Email: phuongnguyens244@gmail.com
Abstract
Objective. Globally, previous research has shown the negative influence of the COVID-19 pandemic on mental health. In fact, Vietnamese culture emphasizes traditional values, and family relationships have an important influence on well-being. However, fewer studies have examined the correlation between family relationships and mental health problems in crises. Hence, this study aims to evaluate the correlation between family relationships and mental health problems among adults during the COVID-19 lockdown in Vietnam.
Material and methods. A sample of 640 adults aged from 18 to 52 (71.9% female) completed an online survey on mental health from August to September 2021. The survey measured depression, anxiety, stress, family relationships, and socio-demographic and epidemiological factors. Multiple linear regressions were conducted.
Results. Prevalence rates of depression, anxiety, and stress were 31.4%, 43.4%, and 25.2%, respectively. Multiple linear regression indicates that 12% to 14% of the variations in common mental health problems can be explained by the family relationship. In particular, family conflicts were significantly related to higher depression, anxiety, and stress (Beta from 0.14 to 0.16, p<0.01); in contrast, an increase in family expressiveness was linked to a decrease in mental health problems (Beta from -0.27 to -0.20, p<0.01).
Conclusions. The mental health of Vietnamese adults was affected due to family conflict and family expressiveness, particularly in crises. The current study provides evidence for the prevention strategy of adult mental health problems by reducing conflict and enhancing emotional expressiveness skills for family members, particularly in crisis situations.
Keywords: family relationship, Vietnamese culture, mental health problem, and the COVID-19 lockdown.
Introduction
COVID-19 was a crisis that had profoundly negative effects on people’s lives. Vietnam is one of the countries severely affected in all aspects of socio-economic life by the COVID-19 pandemic (Nguyễn, Lê, & Nguyễn, 2022). By December 30, 2021, Vietnam had 1,714,742 cases of coronavirus infection, ranking 31st among 224 countries worldwide in the number of COVID-19 infections (Vietnamese Ministry of Health, 2020). In the period from 2020 to 2021, the impact of the COVID-19 pandemic has brought widespread changes in Vietnamese’s lives and health (Phạm, 2020; Đặng, 2021; Hoàng et al., 2021). The interventions mainly focused on preventing the spread of disease to the community and providing medical treatment for patients (Le & Nguyen, 2020). The Vietnamese government enacted prompt and proactive precautions, including the health care system, security forces, and economic policies, along with creative and effective communication campaigns (Tran et al., 2020). However, the consequences of the COVID-19 pandemic have not only affected physical health but also mental health and well-being. Some researchers have identified mental health problems during the COVID-19 pandemic such as fear, boredom, loneliness, anxiety, insomnia, or anger (Shigemura et al., 2020). Therefore, COVID-19 prevention and control measures seem to have only partially solved physical health problems. Meanwhile, less attention has been paid to psychological distress and COVID-19-related post-traumatic stress symptoms (Duan & Zhu, 2020; Xiang et al., 2020).
The family is a unique social group severely affected by the COVID-19 pandemic. Due to the impact of this pandemic, family members have to face negative emotions and more serious mental health problems such as anxiety disorders, emotional disorders, or depression. In fact, economic crises affect people’s mental health due to additional risk factors such as unemployment, debt, and families’ financial stress. These create severe difficulties and psychological pressure on individuals and families (Nguyễn et al., 2022, p. 262). The implementation of social distancing measures and restrictions on public activities has had a significant impact on human psychology. Although public spaces are an outside environment where people expect social interactions, they were forced to limit mass gatherings. Social distancing policies present the dangers of increasing social rejection and the loss of a sense of community. This made people tend not to want to communicate with others. During the quarantine time, people were required to stay at home. This can generate stress, confusion, anxiety, and depression. Anger, boredom, loneliness, and feelings of loss are quite common. The negative impact of control measures as quarantine experience contributes to serious mental health problems not only for families with quarantined relatives but also for patients infected with COVID-19 (Phạm, 2022). The social distancing solution also caused adults to lose their jobs or switch to working from home. Besides, children had to stop going to school and adapt to online learning (Le, 2022). This sudden change causes family members to have to adjust their personal habits. In the home environment, the role of parents for children became even more crucial than before. Children had only their parents around them, and parents not only took care of home-schooling their children but also managed the children and the housework. This leads to conflicts probably happening within the family. In some special situations, many families and family members also coped with stigma and discrimination related to the COVID-19 infection. Losing loved ones and witnessing their deaths due to COVID-19 has had a negative impact on their mental health. Many family members have experienced moderate-to-severe sleep disturbances and fatigue. Besides, individuals did not receive appropriate and immediate psychological intervention support, and their symptoms worsened. COVID-19 might cause severe psychological problems among infected patients, such as depression, anxiety, insomnia, and even suicidal ideation (Phạm, 2022).
Family relationships have a significant impact on the mental health outcomes of family members (Chen & Harris, 2019; Moos, 1994). It can be seen that Western culture promotes individuality, while the family unit is very important in Vietnamese culture. This emphasis on collectivity includes an obligation to provide for the welfare of family members. Family members are expected to work and behave in ways that benefit the group as a whole. Many families in Vietnam are extended families, as many generations co-live to take care of each other. Family in Vietnam looks similar to a system of mini societies. Family relationships are a crucial aspect of life in Vietnam, and this proves that family relationships can be protective and risk factors for individuals. Family relationships in the context of the COVID-19 pandemic are a new situation. It has multidimensional effects on the mental health of adults in the family. However, there have not been many studies about the correlation between family relationships and mental health issues. Vietnam is especially one of the countries heavily affected by the COVID-19 pandemic. Hence, in this study, the authors will clarify the correlation between family relationships and mental health issues among adults. The current study aimed to identify strategies to prevent mental health problems in adults by reducing conflict and improving emotional expression skills for family members.
Material and methods
Participants and procedure
The authors conducted a cross-sectional survey with the consent of 640 adults aged 18 to 52 (71.9% female). The snowball sampling method was applied in the current study. A self-report survey was designed on Microsoft Forms and sent to participants via social networks (Facebook, Zalo) or email. After receiving and completing the questionnaire, participants are encouraged to further share the survey link with other participants. This survey was conducted from August to September 2021, during the Vietnam lockdown due to the COVID-19 epidemic outbreak.
Socio-Demographics and Epidemiological Characteristics
The study collected data on the participants’ sociodemographic and epidemiological characteristics through self-designed questionnaires. The information included their gender, age, infection risk level in their living area, the average time they spent daily on a smartphone, laptop, or iPad, vaccination status, and any background disease they may have had. More detailed descriptions are shown in Table 1.
Table 1
Socio-Demographics and Epidemiological Characteristics (to see Table 1, please click here).
Mental health problems
The Anxiety-Depression-Stress Scale (DASS-21) was used to measure the respective mental health problems of adults. This is a commonly used clinical scale to aid in the diagnosis of depression, anxiety, and stress (7 questions each), as well as an effective tool, widely used in public health research. DASS-21 is the short form of the DASS-42, which was developed by Lovibond and Lovibond (Henry & Crawford, 2005; Lovibond & Lovibond, 1995). It is a self-completed questionnaire with 21 items. Each item describes a negative emotional expression of depression, anxiety, or stress with 4 levels of answers, including (0) “Did not apply to me at all-NEVER“, (1) “Applied to me to some degree, or some of the time-SOMETIMES“, (2) “Applied to me to a considerable degree or a good part of time-OFTEN” and (3) “Applied to me very much or most of the time-ALMOST ALWAYS“. Item scores from 0-3. Higher scores indicate more severe mental health problems. The total score of all items in the same subscale was multiplied by 2 and collated with the DASS-21 severity rating labels to determine the severity of symptoms of depression, anxiety, and stress. The Vietnamese version of DASS-21 has been determined to be highly reliable and valid (Le et al., 2017; Tran, Tran, & Fisher, 2013). The present study also shows high reliability, with the Cronbach’s Alpha coefficients of depression, anxiety, and stress being 0.88, 0.84 and 0.89, respectively.
Family relationships scale
The Brief Version of the Family Relationship Scale (BFRS) was used to measure family relationships on 3 aspects, including conflict (6 items), cohesion (7 items), and expressiveness (3 items), which was used by Fok, Allen, & Henry (2014). The original version of the BFRS Family Relationship Scale was developed by Moos & Moos (1994), with 27 items (Moos, 1994). This is the first time this questionnaire has been used in Vietnam, so we followed the translation and back-translation process for cross-cultural application given by Brislin (Brislin, 1970) to initially create the Vietnamese. In the current research, Cronbach’s alpha coefficient of this scale is 0.74, which ensures its reliability.
Data analyses
In the current research, the authors used descriptive statistics for categorical variables to describe the prevalence of depression, anxiety, and stress. Multiple linear regression analysis was used to assess the relationship between family relationships and mental health problems. In this linear regression model, socio-demographic and epidemiological variables were controlled. All statistics use SPSS 22.0 software.
Results
Prevalence rate of depression, anxiety and stress
The estimated prevalence of mental health problems is shown in Table 2. In the current research, we found that 31.4%, 43.4%, and 25.2% of the adults suffered depression, anxiety, and stress, respectively. Anxiety appears to be the most common mental health problem. 13.3% of adults have severe and extremely severe anxiety. Meanwhile, the prevalence rates of depression and stress at Severe and Extremely Severe levels were only 6.6% and 6.1%, respectively.
Table 2
Prevalence of depression, anxiety and stress among adults during COVID-19 lockdown in Vietnam (to see Table 2, please click here).
The correlations between family relationship and mental health problems
In Table 3, after control for confounding factors, multiple linear regression adjusted R square values were 0.14, 0.12, and 0.13 for models that predict depression, anxiety, and stress, respectively. It means 12% to 14% of the variations in common mental health problems can be explained by the family relationship. In particular, family conflicts were significantly related to higher depression, anxiety and stress (Beta from 0.14 to 0.16, p<0.01); in contrast, an increase in family expressiveness was linked to a decrease in mental health problems (Beta from -0.27 to -0.20, p<0.01). Current study did not find a significantly correlation between family cohesion and mental health problems among Vietnamese adults.
Table 3.
Multiple linear regressions predicting symptoms of common mental health problems from family relationship among adults in Viet Nam (to see Table 3, please click here).
Discussion
This study helps us understand the correlation between family relationships and mental health problems among adults in the unexpected and sudden circumstances of the COVID-19 lockdown in Vietnam. In 2021, governments in many countries around the world implemented social distancing and lockdown policies, including Vietnam (Castex, Dechter, & Lorca, 2021; Glogowsky, Hansen, & Schächtele, 2021; Luu, 2023; Woskie et al., 2021). The initial impact of the unexpected shocks and unprecedented policies on education, health care, and social security appears to have been large. Similar to several studies (Al Dhaheri et al., 2021; Delgado et al., 2021; Ranta, 2022), the consequences of COVID-19 pandemic on the public mental health problems were also presented in this study. It provided statistics and evidence about the effects of COVID-19 on adults’ mental health in Vietnam. Particularly, the present study results show that the prevalence of depression, anxiety, and stress symptoms were 31.4%, 43.4%, and 25.2%, respectively during the COVID-19 lockdown in 2021. Remarkably, anxiety symptoms were the most common mental health problem. These findings were similar to those of previous studies in China, India, Spain, Italy, and Iran (Huang & Zhao, 2020; Lakhan, Agrawal, & Sharma, 2020).
Recently, several research papers highlighted the paramount role of family relationships in the face of adversity. According to their claims, mental health partly depends on high-quality family relationships (Daks, Peltz, & Rogge, 2022; Pietromonaco & Overall, 2021; Sommerlad et al., 2021). The present study found that family relationships can either provide social support or cause mental health problems, which is consistent with previous research by Radicke (Radicke et al., 2021). The current study used three domains such as conflict, cohesion, and expressiveness to measure family relationships (Fok et al., 2014). In fact, family life has been influenced since the early stage of the pandemic by the implementation of physical distancing, quarantine, and staying at home to prevent the spread of coronavirus during the outbreak. Because of the social distance, sheltering-in-place makes more frequent interactions among family members, leading to families struggling during lockdown (Buyukcan-Tetik, Aydin, & Eisma, 2023). In this study, statistical analyses indicated that family conflicts were associated with higher depression and anxiety. The result is consistent with the research in Korea. Kim, Han, Park, and Ryu (2023) illustrated that the experience of family conflict was significantly associated with increased depressive mood and stress due to COVID-19. More specifically, in the study of the Korean population, 75.1% of participants indicated that the time spent with family at home increased after the spread of COVID-19, and 37.4% responded that conflicts among family members increased after the COVID-19 outbreak.
On the contrary, this study also indicated that the high level of family expressiveness has had a positive impact on decreasing mental health problems. Several previous studies showed that a protective factor such as family support has reduced the negative psychological impact ([WHO], 2021; Cao et al., 2020; Torales, O’Higgins, Castaldelli-Maia, & Ventriglio, 2020). These figures, therefore, demonstrated that interactions and support within families were regarded as a protective factor in the presence of mental health conditions. Especially for Vietnamese people, the family has a special significance and a crucial role in the person’s spiritual life. From that perspective, when a family member is in trouble, they are expected to receive both moral and material support from other members. The importance of family ties extends beyond emotional support to include material and financial assistance. While Western culture elevates individual values, Eastern culture, including Vietnam, tends to prioritize building and promoting family relationships. Some authors have highlighted the importance of the Vietnamese family in providing a central support system (Le, 2021; Thuy, 2018).
The findings provide an important snapshot in time of adults with mental health problems during the lockdown. There was no significant correlation found between mental health problems and family cohesion among Vietnamese adults.
The authors concluded by hypothesizing that the family support system must be adaptable in how it approaches assisting families and children. The results of this study recommend early development of universal assistance and family support services, which aid in identifying unique requirements that require specialized care. This approach inspires a categorisation of family support services in five key policy areas (AIHW, 2020; Hardiker, Exton, & Barker, 1991; OECD, 2009) including: basic material needs, health care, family functioning support services, parenting support and early intervention, and specialized services to address specific or complex needs (Riding, Thévenon, Adema, & Dirwan, 2021). Based on this finding, we can conclude that it is crucial to implement effective community, family, and personalized interventions to improve resilience and reduce the risk of mental health crises. Although the results revealed some negative impacts of the COVID-19 outbreak on mental health, it also presents an opportunity for affected countries to improve their preparedness for future health emergencies. It helps us to prevent psychological distress in the population. To face future threats, it is obvious that mental health services in terms of family support must be improved more effectively.
Conclusion and implications
Current results show a high prevalence of psychological problems among Vietnamese adults during the COVID-19 outbreak, in which anxiety seems to be the most common. These psychological problems were positively associated with family conflicts. In contrast, family expressiveness was associated with reduced mental health problems. This implies that intervention strategies that focus on strengthening and improving family relationships are a possible solution in crises such as COVID-19. More importantly, enhancing family expressiveness can be seen as an effective preventive strategy for mental health problems. On the other hand, it is necessary to disseminate messages about reducing conflict and enhancing family expressiveness for adults.
Limitations
The study conducted by the authors has certain limitations that need to be acknowledged. Firstly, due to the COVID-19 lockdown enforced in Vietnam in 2021, the study had to be conducted using a web-based cross-sectional approach. It involved voluntary participation of Vietnamese adults in an online survey during the lockdown period. Hence, the possibility of selection bias should be considered while interpreting the results. Secondly, the sudden emergence of the pandemic made it impossible for the authors to assess the mental health conditions of individuals before the outbreak.
A summary of this paper was presented at the online international conference: Individual, family, society: contemporary challenges, fifth edition, October 4–5, 2023, Bucharest, Romania, and published in the journal Studii şi Cercetări de Antropologie, No. 8/2023.
References
- Al Dhaheri, A. S., Bataineh, M. F., Mohamad, M. N., Ajab, A., Al Marzouqi, A., Jarrar, A. H., . . . Cheikh Ismail, L. (2021). Impact of COVID-19 on mental health and quality of life: Is there any effect? A cross-sectional study of the MENA region. PLoS One, 16(3), e0249107. doi:10.1371/journal.pone.0249107.
- Brislin, R. W. (1970). Back-translation for cross-cultural research. Journal of Cross-Cultural Psychology, 1(3), 185-216. doi:10.1177/135910457000100301.
- Buyukcan-Tetik, A., Aydin, C., & Eisma, M. C. (2023). Similar minds in the family: COVID-19 centrality and relationship quality. Personal Relationships, 30(3), 806-824. doi:https://doi.org/10.1111/pere.12479.
- Cao, W., Fang, Z., Hou, G., Han, M., Xu, X., Dong, J., & Zheng, J. (2020). The psychological impact of the COVID-19 epidemic on college students in China. Psychiatry Res, 287, 112934. doi:10.1016/j.psychres.2020.112934.
- Castex, G., Dechter, E., & Lorca, M. (2021). COVID-19: The impact of social distancing policies, cross-country analysis. Econ Disaster Clim Chang, 5(1), 135-159. doi:10.1007/s41885-020-00076-x.
- Chen, P., & Harris, K. M. (2019). Association of Positive Family Relationships With Mental Health Trajectories From Adolescence to Midlife. JAMA Pediatr, 173(12), e193336. doi:10.1001/jamapediatrics.2019.3336.
- Daks, J. S., Peltz, J. S., & Rogge, R. D. (2022). The impact of psychological flexibility on family dynamics amidst the COVID-19 pandemic: A longitudinal perspective. J Contextual Behav Sci, 26, 97-113. doi:10.1016/j.jcbs.2022.08.011.
- Delgado, C. E., Silva, E. A., Castro, E. A. B., Carbogim, F. D. C., Püschel, V. A. A., & Cavalcante, R. B. (2021). COVID-19 infodemic and adult and elderly mental health: a scoping review. Rev Esc Enferm USP, 55, e20210170. doi:10.1590/1980-220x-reeusp-2021-0170.
- Duan, L., & Zhu, G. (2020). Psychological interventions for people affected by the COVID-19 epidemic. Lancet Psychiatry, 7(4), 300-302. doi:10.1016/s2215-0366(20)30073-0.
- Đặng, N. A. (2021). Ảnh hưởng của đại dịch COVID-19 đến sức khỏe tinh thần. Tạp chí khoa học xã hội, số, 10.
- Fok, C. C., Allen, J., & Henry, D. (2014). The brief family relationship scale: a brief measure of the relationship dimension in family functioning. Assessment, 21(1), 67-72. doi:10.1177/1073191111425856.
- Glogowsky, U., Hansen, E., & Schächtele, S. (2021). How effective are social distancing policies? Evidence on the fight against COVID-19. PLoS One, 16(9), e0257363. doi:10.1371/journal.pone.0257363.
- Hardiker, P., Exton, K. E. N., & Barker, M. (1991). The Social Policy Contexts of Prevention in Child Care. The British Journal of Social Work, 21(4), 341-359. doi:10.1093/oxfordjournals.bjsw.a055771.
- Henry, J. D., & Crawford, J. R. (2005). The short-form version of the Depression Anxiety Stress Scales (DASS-21): Construct validity and normative data in a large non-clinical sample [Press release].
- Hoàng, M. N., Hòa, T. H. H., Trần, T. H. V., Nguyễn, T. Q., Nguyễn, T. P. L., Hạc, V. V., & Trịnh, Q. G. (2021). Ảnh hưởng của đại dịch COVID–19 đến công việc, cuộc sống và sức khỏe tâm thần của người dân tỉnh Thái Nguyên năm 2020. Tạp chí Y học Dự phòng, 31(2), 49-55.
- Huang, Y., & Zhao, N. (2020). Generalized anxiety disorder, depressive symptoms and sleep quality during COVID-19 outbreak in China: a web-based cross-sectional survey. Psychiatry Res, 288, 112954. doi:10.1016/j.psychres.2020.112954.
- Kim, M. S., Han, M. A., Park, J., & Ryu, S. Y. (2023). Association Between Changes in Family Life Due to COVID-19 and Depressive Mood and Stress Perception. Asia Pac J Public Health, 35(1), 14-20. doi:10.1177/10105395221139346.
- Lakhan, R., Agrawal, A., & Sharma, M. (2020). Prevalence of Depression, Anxiety, and Stress during COVID-19 Pandemic. J Neurosci Rural Pract, 11(4), 519-525. doi:10.1055/s-0040-1716442.
- Le, M. T. H., Tran, T. D., Holton, S., Nguyen, H. T., Wolfe, R., & Fisher, J. (2017). Reliability, convergent validity and factor structure of the DASS-21 in a sample of Vietnamese adolescents. PLoS One, 12(7), e0180557. doi:10.1371/journal.pone.0180557.
- Le, T. K. D. (2021). Characteristics of traditional Vietnamese family and its influence on communication culture in the family. Journal of Anthropological researches and studies, 49-64, Retrieved from https://www.journalstudiesanthropology.ro/en/no-13-2023/.
- Le, T. K. D. (2022). Internet and communication between parents and children in urban Vietnamese families. Doctoral thesis in sociology. (PhD), Bucharest University, Romania.
- Le, T. K. D., & Nguyen, T. N. T. (2020). Internet and COVID-19 Pandemic Response Strategies in Vietnam. The scientific annals of the “Alexandru Ioan Cuza” University of Iasi, volume Xiii / 1, Sociology and Social assistance, 2020. https://doi.org/10.47743/asas-2020-1.
- Lovibond, P. F., & Lovibond, S. H. (1995). The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour Research and Therapy, 33(3), 335-343. doi:https://doi.org/10.1016/0005-7967(94)00075-U.
- Luu, D. T. H. (2023). What Vietnam’s localized lockdown policy showed: it did not work and was too late. Regional Studies, 57(9). doi:10.1080/00343404.2022.2137486
- Moos RH, M. B. (1994). Family Environment Scale Manual: 3rd. Palo Alto, CA: Consulting Psychologists Press.
- (2009). Doing Better for Children. Retrieved from http://www.oecd.org/els/family/43552898.pdf.
- Nguyễn, T. T., Lê, T. T. X., & Nguyễn, T. T. H. (2022). Tác động của dịch COVID-19 đến sức khoẻ tâm thần của người dân trên 18 tuổi năm 2020. Tạp chí Y học Việt Nam, 517(2). https://doi.org/10.51298/vmj.v517i2.3277.
- Park, S. C., & Park, Y. C. (2020). Mental Health Care Measures in Response to the 2019 Novel Coronavirus Outbreak in Korea. Psychiatry Investig, 17(2), 85-86. doi:10.30773/pi.2020.0058.
- Pham, H. C. (2020). Tác động của đại dịch COVID-19 đến nền kinh tế việt nam. Tạp chí Kinh tế và Phát triển, 274, 12.
- Phạm, T. D. (2022). Đại dịch COVID-19 ảnh hưởng đến sức khỏe tâm thần. Retrieved from https://soyt.langson.gov.vn/vi/node/7105#:~:text=Th%E1%BB%9Di%20gian%20g%E1%BA%A7n%20%C4%91%C3%A2y%2C%20nhi%E1%BB%81u,ng%E1%BB%B1c%2C%20%C4%91au%20%C4%91%E1%BA%A7u.
- Pietromonaco, P. R., & Overall, N. C. (2021). Applying relationship science to evaluate how the COVID-19 pandemic may impact couples’ relationships. Am Psychol, 76(3), 438-450. doi:10.1037/amp0000714.
- Radicke, A., Sell, M., Adema, B., Daubmann, A., Kilian, R., Busmann, M., . . . Wiegand-Grefe, S. (2021). Risk and Protective Factors Associated With Health-Related Quality of Life of Parents With Mental Illness. Front Psychiatry, 12, 779391. doi:10.3389/fpsyt.2021.779391.
- Ranta, M., Mastrotheodoros, S. . (2022). The effects of COVID-19 on young people’s mental health and psychological well-being: An updated literature review. Retrieved from
- Riding, S., Thévenon, O., Adema, W., & Dirwan, G. (2021). Looking beyond COVID-19. doi:https://doi.org/10.1787/86738ab2-en.
- Sommerlad, A., Marston, L., Huntley, J., Livingston, G., Lewis, G., Steptoe, A., & Fancourt, D. (2021). Social relationships and depression during the COVID-19 lockdown: longitudinal analysis of the COVID-19 Social Study. Psychol Med, 1-10. doi:10.1017/s0033291721000039.
- Thuy, L. T. B. (2018). Vietnamese Family Culture in the Context of International Integration. World Journal of Social Sciences and Humanities, 4(3), 170-176. doi:10.12691/wjssh-4-3-5.
- Torales, J., O’Higgins, M., Castaldelli-Maia, J. M., & Ventriglio, A. (2020). The outbreak of COVID-19 coronavirus and its impact on global mental health. Int J Soc Psychiatry, 66(4), 317-320. doi:10.1177/0020764020915212.
- Tran, T. D., Tran, T., & Fisher, J. (2013). Validation of the depression anxiety stress scales (DASS) 21 as a screening instrument for depression and anxiety in a rural community-based cohort of northern Vietnamese women. BMC Psychiatry, 13(1), 24. doi:10.1186/1471-244X-13-24.
- Vietnamese Ministry of Health. (2020). Bản tin cập nhật COVID-19 tính đến 16h00 ngày 30/12/2021. Retrieved from https://vncdc.gov.vn/ban-tin-cap-nhat-COVID-19 -tinh-den-16h00-ngay-30122021-nd16768.html.
- Woskie, L. R., Hennessy, J., Espinosa, V., Tsai, T. C., Vispute, S., Jacobson, B. H., . . . Gabrilovich, E. (2021). Early social distancing policies in Europe, changes in mobility & COVID-19 case trajectories: Insights from Spring 2020. PLoS One, 16(6), e0253071. doi:10.1371/journal.pone.0253071.
- Xiang, Y. T., Yang, Y., Li, W., Zhang, L., Zhang, Q., Cheung, T., & Ng, C. H. (2020). Timely mental health care for the 2019 novel coronavirus outbreak is urgently needed. Lancet Psychiatry, 7(3), 228-229. doi:10.1016/s2215-0366(20)30046-8.
- Zandifar, A., & Badrfam, R. (2020). Iranian mental health during the COVID-19 epidemic. Asian J Psychiatr, 51, 101990. doi:10.1016/j.ajp.2020.101990.
- ***AIHW. (2020). Family support services in Australia 2000. Canberra: Australian Institute of Health and Welfare.
- ***[WHO], W.H.O. (2021). Mental Health and Psychosocial Considerations during the COVID-19 Outbreak. Retrieved from https://www.who.int/docs/default-source/coronaviruse/mental-health-considerations.pdf.