Mental Health Outcomes and Occupational Stress Among Malaysian Frontline Workers During the COVID-19 Pandemic

<b>Background:</b> The COVID-19 pandemic significantly affected the mental health of frontline healthcare workers. This study investigated the mental health and occupational stressors faced by frontline workers in Selangor during the pandemic. <b>Methods:</b> A cross-sectional study was conducted using secondary data from the Mental Health and Psychosocial Support Services team, collected from March to August 2020. A total of 4593 frontline workers participated in the Depression, Anxiety, and Stress Scale screening. <b>Results:</b> Mental health symptoms were common among frontline workers during the COVID-19 pandemic, with 14.8% reporting stress, 30.7% anxiety, and 20.4% depression. Female workers had significantly higher odds of all three conditions, with adjusted odds ratios (aOR) of 1.35 (95% CI: 1.10-1.66) for stress, 1.25 (95% CI: 1.07-1.47) for anxiety, and 1.23 (95% CI: 1.03-1.47) for depression. Workers aged 18-30 had higher odds of stress (aOR 1.88; 95% CI: 1.42-2.47), anxiety (aOR 1.74; 95% CI: 1.43-2.12), and depression (aOR 1.80; 95% CI: 1.43-2.27) compared with those over 40. Employment in hospitals was associated with increased odds of all three conditions, with aORs ranging from 1.71 to 2.05. Among 711 respondents who reported occupational stressors, lack of mental health support was the strongest predictor (aORs 4.91-5.20), followed by poor work rotation and conflict with supervisors. <b>Conclusions:</b> Women, younger staff, and hospital workers were more vulnerable to mental health symptoms during the pandemic. Organizational factors, especially limited support and poor work arrangements, played a major role. Targeted mental health services and improved working conditions are needed to support healthcare workers in future emergencies.