Abstract
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 (R 2 ), 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.