Key findings
This study highlights a significant burden of psychological distress among healthcare workers in Kabul, with one in four participants reporting clinically relevant symptoms in the immediate aftermath of the August 2021 political transition. Stress-induced reactivity emerged as the most prevalent symptom, followed by ruminative sadness without social withdrawal and somatic distress, and sadness with social withdrawal and somatic distress. The intention to leave the country was reported by a substantial proportion of healthcare workers and was significantly associated with psychological distress, echoing findings from other conflict settings. Gender disparities also emerged, with female healthcare workers experiencing significantly higher odds of both stress-induced reactivity and sadness with social withdrawal and somatic symptoms. Lack of optimism about the future was a consistent associated factor of all psychological distress symptoms. These findings reflect both the psychosocial strain experienced by healthcare workers and the broader context of fear, uncertainty, and systemic instability.
Comparison with existing literature
The results align with global evidence from conflict and post-conflict settings, where high levels of psychological distress have been consistently documented among healthcare providers [25]. The stress-induced reactivity observed in this study, characterized by heightened nervousness, irritability, and emotional volatility, is consistent with findings from Yemen, where healthcare workers described ongoing exposure to war-related trauma as undermining their sense of professional efficacy and emotional resilience [26]. Similarly, healthcare workers in Gaza continued to report severe mental health symptoms two years after the end of active hostilities, underscoring the long-lasting psychological toll of political instability [27]. In Myanmar, a post-conflict study among healthcare providers identified significant sources of stress and psychological vulnerability related to both direct trauma and systemic uncertainty [21].
Comparable prevalence rates of anxiety and depression have been reported in Bosnia and Herzegovina, where 22% of medical residents showed post-war symptoms of psychological distress [28], and among Sri Lankan nurses caring for conflict victims, where prevalence rates were estimated at 21% [29]. The distress prevalence found in this study is lower than estimates from conflict-affected Libya, where extreme levels of psychological strain were reported among health personnel [30]. Variations in prevalence may reflect differences in timing, exposure levels, political context, and access to support services [31].
The factor of intention of HCWs to leave the country found in this study is consistent with other findings in the conflict setting. A national survey of hospitals in Uganda revealed that 46% of healthcare professionals were considering exiting the sector or emigrating, although this proportion was lower than observed in this Afghan sample [22]. In Nigeria, the emigration intent among healthcare workers was found to be even higher, exceeding Afghanistan’s figures by 1.5 times [32]. These findings reinforce the role of systemic fragility and perceived professional insecurity in fueling mental health deterioration and workforce attrition.
Affected by chronic war, Afghan women face multifaceted challenges with multiple factors triggering their susceptibility towards mental health issues [33]. Factors such as Gender-based Violence, forced marriages, traditional customs and practices [34], limited learning and skill-building opportunities [35], exacerbated with severe political instability, poverty, hunger, and inconsistent governmental policies which practically reduce the women contribution [36] contribute to the poor mental health status of Afghan women. Built on the contextual factors and gender norms in Afghanistan, findings of this study indicate higher odds of psychological distress among females, aligning with other relevant results among Afghan women [37, 38]. In addition, the elucidated pattern is consistent with prior studies highlighting gender-based vulnerability in conflict zones, where women often face compounded stressors linked to caregiving responsibilities, workplace discrimination, and sociocultural expectations. The intersection of gender and insecurity appears to amplify emotional strain and reduce perceived coping capacity.
As an associated factor, lack of optimism about the emphasizes the importance of hope and perceived agency as protective psychological factors. Insecurity about job stability, national governance, and personal safety may erode healthcare workers’ morale and fuel feelings of helplessness, thereby exacerbating mental health symptoms.
Policy implications and future research
Despite the limitations encountered during the study implementation, the study offers valuable insights into the psychological wellbeing of healthcare workers in a fragile, post-conflict environment. The findings of this study present a unique and a rarely documented scenario of HCWs response immediately after the rapid systematic changes, which can help the policy makers integrate plans for such unforeseen circumstances. Furthermore, It underscores the urgent need for sustainable mental health infrastructure tailored to the specific stressors encountered by health personnel. Organizational support systems, policy-level reforms, and targeted psychosocial interventions will be critical in preventing burnout, improving resilience, and retaining the health workforce in Afghanistan. Furthermore, its recommended to expand the structure of tertiary hospitals to recruit psychosocial officers as official personnel of the hospital, benefiting from the public budget allocated for the hospitals. This initiative would improve the feasibility of seeking for psychosocial support in the hospital-level with no out-of-pocket expenses for the HCWs of the tertiary hospitals.
Future research should include longitudinal assessments to track mental health outcomes over time and evaluate changes in distress as political and institutional conditions evolve. Moreover, studies focusing on resilience-building strategies, social support networks, and coping mechanisms among Afghan HCWs could inform culturally grounded mental health interventions and policy development.
Limitations
Several limitations of this study should be acknowledged. First, data collection was limited to public tertiary hospitals in Kabul, excluding private healthcare facilities and rural or community-level health centers. However, it’s noteworthy to mention that the current findings highlight the pattern and burden of psychological distress after a nation-wide political transition, which was not limited to Kabul, hence extending the generalizability of the findings. Furthermore, the cadres included in this study make the core public health workforce backbone of the country, hence reflecting the representativeness of the HCWs in this study. On the other hand, the selected hospitals for this study serve as referral hub for the complicated cases from across the country and serve for disproportionate patient loads, particularly during instabilities, which often represent system-wide norms in clinical practice and coping behaviors. Therefore, with the acknowledgement of institutional and geographical limitation, systematic exposure, occupational composition, and high patient loads support the relevance of our findings to similar public-sector healthcare context across the country.
Second, the descriptive nature of the study precludes causal inferences and does not allow for exploration of underlying mechanisms driving psychological distress. Third, the study was conducted during a sensitive political period, and participants may have been reluctant to fully disclose their mental health concerns, introducing potential response bias. Lastly, the high rate of professional emigration in the immediate post-transition period may have introduced selection bias, as those most affected may have already exited the workforce.
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