Abstract
Healthcare workers experienced psychological distress during the COVID-19 pandemic, particularly in the form of intrusive thoughts and heightened death anxiety. Vaccination is expected not only reduce infection risk but also reduce psychological burden. The aim of the present study was to examine the relationship among COVID-19 obsessions, emotional exhaustion, and death anxiety and examined whether vaccine acceptance moderates these association among medical staff. Cross-sectional designs were adopted in this study, and data was collected from 200 members of the medical staff (doctors, nurses, and paramedical personnel). All the study’s participants were vaccinated at the time of data collection. PLS-SEM was used to analyze the data. The sample had a high exposure of COVID-19, with 63% previously infected, and female staff reported high level of obsession, emotional exhaustion and death anxiety. Vaccine acceptance was high across the sample (86%). Moreover, hypothesis testing results showed that COVID-19 obsession was found to be associated with death anxiety (β = 0.271; t = 5.120; p = 0.000). Vaccine acceptance also influences the relationship between COVID-19 obsession and death anxiety (β= -0.263; t = 4.393; p = 0.000). Vaccine acceptance is a psychosocial protective factor for frontline healthcare professionals by diminishing their experiences of obsessive thoughts and fear of dying related to COVID-19. Enhancing vaccination campaigns, while incorporating psychological support into workplace health programs, is likely to improve the psychological health and resilience of frontline healthcare workers. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-026-14338-z.