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Ervin J, Fleitas Alfonzo L, Taouk Y, Maheen H, King T. Unpaid caregiving and mental health during the COVID-19 pandemic-A systematic review of the quantitative literature. PLoS One 2024; 19:e0297097. [PMID: 38635604 PMCID: PMC11025839 DOI: 10.1371/journal.pone.0297097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 12/19/2023] [Indexed: 04/20/2024] Open
Abstract
The COVID-19 pandemic imposed additional and specific challenges on the lives and wellbeing of informal unpaid carers. Addressing an important gap in the existing literature, this systematic review (prospectively registered with PROSPERO CRD42022376012) synthesises and evaluates the quantitative evidence examining the association between unpaid caregiving and mental health (compared to non-caring), during the pandemic. Five databases were searched (Medline, PsycInfo, EMBASE, Scopus, Web of Science) from Jan 1, 2020, to March 1, 2023. Population-based, peer-reviewed quantitative studies using any observational design were included, with screening, data extraction and quality assessment (amended NOS) independently conducted by two reviewers. Of the 3,073 records screened, 20 eligible studies (113,151 participants) were included. Overall quality of evidence was moderate. Narrative synthesis was complemented by Effect-direction and Albatross plots (given significant between-study heterogeneity precluded meta-analysis). Results indicate that the mental health of informal carers, already poorer pre-COVID compared to non-caregivers, was disproportionally impacted as a result of the pandemic and its associated public health containment measures. This review highlights the vulnerability of this group and should motivate political will and commensurate policies to ensure unpaid caregivers are better supported now, in the medium term, and crucially if, and when, another global public health emergency emerges.
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Affiliation(s)
- Jennifer Ervin
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Ludmila Fleitas Alfonzo
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Yamna Taouk
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Humaira Maheen
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Tania King
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
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Sasaki Y, Okubo R, Takeda K, Ikezawa S, Tabuchi T, Shirotsuki K. The association between emotion malleability beliefs and severe psychological distress stratified by sex, age, and presence of any psychiatric disorders. Front Psychol 2023; 14:1251945. [PMID: 37881216 PMCID: PMC10597715 DOI: 10.3389/fpsyg.2023.1251945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/22/2023] [Indexed: 10/27/2023] Open
Abstract
Background Recent studies have shown an association between psychological distress and emotion malleability beliefs, meaning mindsets about whether one's emotions are fixed or changeable. However, most studies have not examined the association between these beliefs and sociodemographic factors. Methods A nationwide cross-sectional Internet survey of residents of Japan aged 15-79 years was conducted using sampling weights for national estimates to investigate the association between emotion malleability beliefs and sociodemographic factors and between fixed beliefs and severe psychological distress (SPD). SPD was defined as a Kessler 6 Scale score of ≥13. Adjusted odds ratios for SPD were calculated considering potential confounders. Further analyses were stratified by sex, age and presence of any psychiatric disorder. Results The analysis included 23,142 participants (female, 48.64%). Fixed beliefs were associated with female sex, age < 45 years, and presence of psychiatric disorders. These beliefs were associated with SPD, and additional analysis showed stronger associations with SPD among female respondents, respondents aged 45-59 years, and those aged ≥60 years. Conclusion Results indicate that female sex, age < 45 years, and current mental disorders were associated with fixed emotion malleability beliefs. Associations between fixed emotion malleability beliefs and SPD were particularly strong among female respondents and people aged ≥45 years compared with the general population. Our study extends the association between emotion malleability beliefs and psychological health to the general population. Future studies should explore mechanisms underlying individual differences in emotion beliefs.
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Affiliation(s)
- Yohei Sasaki
- Department of Human Sciences, Faculty of Human Sciences, Musashino University, Koto-ku, Japan
| | - Ryo Okubo
- Department of Psychiatry and Neurology, National Hospital Organization Obihiro Hospital, Hokkaido, Japan
| | - Kazuyoshi Takeda
- Department of Clinical Data Science, Clinical Research and Education Promotion Division, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Satoru Ikezawa
- Graduate School of Arts and Sciences, The University of Tokyo, Tokyo, Japan
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Kentaro Shirotsuki
- Department of Human Sciences, Faculty of Human Sciences, Musashino University, Koto-ku, Japan
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Stickley A, Shirama A, Sumiyoshi T. Psychotic experiences, perceived stress, and suicidal ideation among the general population during the COVID-19 pandemic: Findings from Japan. Schizophr Res 2023; 260:49-55. [PMID: 37625223 DOI: 10.1016/j.schres.2023.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 05/16/2023] [Accepted: 07/23/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Psychotic experiences (PEs) have been linked to suicidality. However, little is known about the mechanisms underlying this association. This cross-sectional study examined the role of perceived stress in the association between PEs and suicidal ideation in the general population during the COVID-19 pandemic, which has been linked to high levels of stress and an increase in suicidal behavior. METHODS Data were analyzed from an online sample of 1452 Japanese individuals aged 18 to 89 that were collected in February 2021. Information was obtained on past-year suicidal ideation and PEs, which were assessed with the PRIME Screen-Revised (PS-R). Perceived stress was measured with the Perceived Stress Scale (PSS-14). Logistic regression was used to examine associations. RESULTS In an analysis adjusted for sociodemographic factors, PEs were associated with 2.4 times higher odds for past-year suicidal ideation. However, further adjusting the analysis for mental health (depressive symptoms) attenuated the association (OR: 1.49, 95%CI: 0.76-2.93). In an analysis adjusted for mental health, individuals with PEs and perceived stress had significantly higher odds for suicidal ideation (OR: 4.77, 95%CI: 1.83-12.44), while PEs without perceived stress were not linked to suicidal thoughts (OR: 0.47, 95%Cl: 0.13-1.77). A further analysis showed that stress mediated the PEs-suicidal ideation association. CONCLUSIONS Self-perceived stress plays an important role in the association between PEs and suicidal ideation. The detection and management of stress in people with PEs may help prevent negative outcomes such as suicidal thoughts and behaviors in this population.
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Affiliation(s)
- Andrew Stickley
- Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-cho, Kodaira, Tokyo 187-8553, Japan.
| | - Aya Shirama
- Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-cho, Kodaira, Tokyo 187-8553, Japan
| | - Tomiki Sumiyoshi
- Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-cho, Kodaira, Tokyo 187-8553, Japan
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Tan Dat N, Mitsui N, Asakura S, Fujii Y, Toyoshima K, Kusumi I. Relationship between self-esteem and suicidal ideation before and during COVID-19 in a non-clinical sample: mediating effects of psychological distress and hopelessness. Front Psychiatry 2023; 14:1240715. [PMID: 37743986 PMCID: PMC10512949 DOI: 10.3389/fpsyt.2023.1240715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 08/21/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction Several studies have highlighted the impact of the novel coronavirus disease (COVID-19) pandemic on suicide. Accordingly, investigating the risk factors of suicide during this crisis is important. Based on the escape theory of suicide, the current study examined the serial mediating roles of psychological distress and hopelessness in the relationship between self-esteem and suicidal ideation. It also aimed to explore whether or not the COVID-19 pandemic changed the mediation effect in any way. Methods Data were collected from 645 university students before and during the pandemic. The study employed mediation and multi-group analyses to test the hypotheses. Results The results demonstrated that individuals with low self-esteem reported high psychological distress, which further lead to hopelessness and eventually heightened suicidal ideation. Multi-group analysis revealed that psychological distress exerted a greater impact on suicidal ideation during COVID-19. Discussion The finding suggested that self-esteem, hopelessness, and psychological distress could help elucidate the development of suicidal ideation. Clinicians may target these factors in suicide prevention programs, particularly in the settings of the COVID-19 pandemic or future crisis.
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Affiliation(s)
- Nguyen Tan Dat
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Nobuyuki Mitsui
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Satoshi Asakura
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan
- Health Care Center of Hokkaido University, Sapporo, Japan
| | - Yutaka Fujii
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan
- Health Care Center of Hokkaido University, Sapporo, Japan
| | - Kuniyoshi Toyoshima
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Ichiro Kusumi
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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5
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Nicoll G, Vincent J, Gajaria A, Zaheer J. A trauma-informed approach to suicide prevention for the COVID-19 pandemic. Psychiatry Res 2023; 327:115407. [PMID: 37579538 DOI: 10.1016/j.psychres.2023.115407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 07/31/2023] [Accepted: 08/05/2023] [Indexed: 08/16/2023]
Abstract
During the COVID-19 pandemic, researchers have questioned how the devastation of the pandemic might impact suicide rates. While initial evidence on suicide rates during the early stages of the pandemic is mixed, there are signs we should still remain vigilant. One way of conceptualizing the long-term effects of the pandemic is as a source of multiple traumatic events: the collective trauma of widespread illness and death and social upheaval, individual traumas from the virus itself (e.g., serious illness and disability, traumatic grief, vicarious trauma), traumas from the social and economic consequences (e.g., domestic violence, unemployment), and its intersections with pre-pandemic traumas and oppression. Given trauma is a well-established risk factor for suicide, this carries significant implications for suicide prevention in the wake of the pandemic. Yet access to trauma-informed care, education, and research remains limited. The pandemic presents a unique opportunity to address these gaps and implement a trauma-informed approach to suicide prevention. Building on existing frameworks, we describe how effective suicide prevention for the pandemic must incorporate trauma-informed and trauma-specific services, strategies, and policies; capacity building; collaborative research; and knowledge exchange. Attending to the traumatic effects of the pandemic may reduce the long-term impact on suicide rates.
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Affiliation(s)
- Gina Nicoll
- Department of Psychology, Faculty of Arts & Science, University of Toronto, Toronto, Ontario, Canada; Institute for Medical Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Jacqueline Vincent
- St. Michael's Hospital, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Amy Gajaria
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Juveria Zaheer
- Institute for Medical Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
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Yoshioka T, So R, Takayama A, Okubo R, Funada S, Takada M, Wakabayashi M, Tabuchi T. Strong chū-hai, a Japanese ready-to-drink high-alcohol-content beverage, and hazardous alcohol use: A nationwide cross-sectional study. Alcohol Clin Exp Res 2023; 47:285-295. [PMID: 36478596 DOI: 10.1111/acer.14991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 11/23/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND A new ready-to-drink premixed high-alcohol-content beverage, called strong chū-hai, was launched in Japan, and more recently, in Taiwan and Australia. We aimed to examine the popularity and association of strong chū-hai with individual alcohol use, both of which remained unclear. METHODS We conducted a cross-sectional study using data from the Japan "Society and New Tobacco" Internet Survey conducted from February 1 to 28, 2022, in Japan. We enrolled 27,993 respondents (aged 15 to 81 years; male 48.5%), including 15,083 current alcohol users. Using inverse probability weighting of data from the 2016 Comprehensive Survey of Living Conditions on Health and Welfare, we estimated the weighted proportions of strong chū-hai users among all respondents and constructed multivariable logistic regression models to estimate the weighted odds ratios (OR) and 95% confidence intervals (CI) of strong chū-hai use for hazardous and harmful alcohol use, defined as a score ≥8 of the Alcohol Use Disorder Identification Test, among current alcohol users. RESULTS Among all respondents, 56.2% (weighted proportions: past, 35.9%; and current, 20.3%) drank strong chū-hai. Among drinkers, both past and current strong chū-hai use, compared to never use, were associated with hazardous and harmful alcohol use (past, OR 1.73, 95% CI 1.42 to 2.12; current, OR 2.19, 95% CI 1.79 to 2.69). CONCLUSIONS Our study found that more than half of the respondents experienced strong chū-hai consumption, suggesting that it is widely used in Japan. In addition, both past and current strong chū-hai use were associated with hazardous and harmful alcohol use among current alcohol users.
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Affiliation(s)
- Takashi Yoshioka
- Department of Preventive Medicine and Public Health, School of Medicine, Keio University, Tokyo, Japan
| | - Ryuhei So
- Department of Psychiatry, Okayama Psychiatric Medical Center, Okayama, Japan
| | - Atsushi Takayama
- Department of Pharmacoepidemiology, Kyoto University Graduate School of Medicine and Public Health, Kyoto, Japan
| | - Ryo Okubo
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Satoshi Funada
- Department of Preventive Medicine and Public Health, School of Medicine, Keio University, Tokyo, Japan.,Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Midori Takada
- Department of Cardiovascular Disease Prevention, Osaka Center for Cancer and Cardiovascular Disease Prevention, Osaka, Japan
| | - Mami Wakabayashi
- Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan.,The Tokyo Foundation for Policy Research, Tokyo, Japan
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7
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Kikuchi K, Anzai T, Takahashi K. The Unusual Increase in Suicides Among Women in Japan During the COVID-19 Pandemic: A Time-series Analysis Until October 2021. J Epidemiol 2023; 33:45-51. [PMID: 36244746 PMCID: PMC9727214 DOI: 10.2188/jea.je20220186] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Japan has witnessed an unusual increase in the number of suicides among women during the coronavirus disease 2019 pandemic. An analysis is required to identify the influencing factors during the pandemic and develop new measures for preventing suicides. METHODS Data on the number of monthly suicides were collected from the National Police Agency of Japan. The expected number of suicides among women during the pandemic was estimated using a time-series model based on pre-pandemic data, considering year-to-year trends. The observed-to-expected (O/E) ratio of suicides was estimated from March 2020 to October 2021 using job status, suicide motive, and age. RESULTS The number of suicides among women in Japan increased beyond the expected number until October 2021. The O/E ratio based on job status, suicide motive, and age (except self-employed, unknown job status, and women aged ≥80 years) was significantly above 1.0 from March-December 2020, and the increase in suicides continued in almost all categories in 2021. CONCLUSION Although several reasons were reported for increased suicides among women in Japan during the pandemic (eg, economic downturn, financial instability, and loneliness), suicides increased irrespective of job status, suicide motive, or age. Comprehensive measures to prevent suicide might have been important during the pandemic, instead of limiting interventions to the reported specific population.
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Affiliation(s)
- Kohtaro Kikuchi
- Department of Biostatistics, M&D Data Science Center, Tokyo Medical and Dental University, Tokyo, Japan,Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Tatsuhiko Anzai
- Department of Biostatistics, M&D Data Science Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kunihiko Takahashi
- Department of Biostatistics, M&D Data Science Center, Tokyo Medical and Dental University, Tokyo, Japan
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Choe H, Gondo Y, Kasuga A, Masui Y, Nakagawa T, Yasumoto S, Ikebe K, Kamide K, Kabayama M, Ishizaki T. The Relationship Between Social Interaction and Anxiety Regarding COVID-19 in Japanese Older Adults. Gerontol Geriatr Med 2023; 9:23337214231175713. [PMID: 37255654 PMCID: PMC10225903 DOI: 10.1177/23337214231175713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/23/2023] [Accepted: 04/24/2023] [Indexed: 06/01/2023] Open
Abstract
While previous studies suggest that women have higher anxiety than men regarding COVID-19, underlying mechanisms remain unclear. This study tries to explain the mechanisms by gender difference in social interaction based on a theory of social amplification of risk framework (SARF). We surveyed older adults in Japan regarding their anxiety regarding COVID-19, as well as the frequencies of their direct and indirect social interaction in July 2020 (N = 1,587, aged 78-99 years). To explore the way in which gender and anxiety regarding COVID-19 were mediated by these two types of social interactions, MODEL4 of SPSS's Process MACRO was applied to the data. We found that older women interacted more directly and indirectly with others than did older men. And, direct social interaction was negatively and related, but indirect social interaction was positively related to older adults' anxiety regarding COVID-19. Furthermore, direct social interaction was related to older women's low anxiety regarding COVID-19, whereas indirect social interaction was related to older women's high anxiety regarding COVID-19. The findings of our study suggest that the degree of anxiety regarding COVID-19 among older women may be dependent upon the types of social interaction they have with others.
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Affiliation(s)
- Hwang Choe
- Osaka University Graduate School of
Human Sciences Clinical Thanatology and Geriatric Behavioral Science, Suita,
Japan
| | - Yasuyuki Gondo
- Osaka University Graduate School of
Human Sciences Clinical Thanatology and Geriatric Behavioral Science, Suita,
Japan
| | - Ayaka Kasuga
- Osaka University Graduate School of
Human Sciences Clinical Thanatology and Geriatric Behavioral Science, Suita,
Japan
| | - Yukie Masui
- Tokyo Metropolitan Institute of
Gerontology, Japan
| | | | - Saori Yasumoto
- Osaka University Graduate School of
Human Sciences, Japan
| | - Kazunori Ikebe
- Osaka University School of Dentistry
Graduate School of Dentistry, Japan
| | - Kei Kamide
- Osaka University School of Medicine
Graduate School of Medicine, Japan
| | - Mai Kabayama
- Osaka University School of Medicine
Graduate School of Medicine, Japan
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Midorikawa H, Tachikawa H, Aiba M, Shiratori Y, Sugawara D, Kawakami N, Okubo R, Tabuchi T. Proposed Cut-Off Score for the Japanese Version of the Fear of Coronavirus Disease 2019 Scale (FCV-19S): Evidence from a Large-Scale National Survey in Japan. Int J Environ Res Public Health 2022; 20:ijerph20010429. [PMID: 36612751 PMCID: PMC9819218 DOI: 10.3390/ijerph20010429] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/20/2022] [Accepted: 12/23/2022] [Indexed: 05/28/2023]
Abstract
The Fear of coronavirus disease 2019 (COVID-19) Scale (FCV-19S) is a seven-item self-administered psychological scale for measuring the fear of this disease. The scale has been widely adapted and validated worldwide. This study aimed to propose a cut-off score for the validated Japanese version of the FCV-19S. We conducted a nationwide online survey and included 26,286 respondents in the analysis. Respondents answered questions on their sociodemographic characteristics, and using the FCV-19S and six-item Kessler Psychological Distress Scale, we measured psychological distress and assessed whether the fear of COVID-19 interfered with their daily lives. A total score of ≥21 points was considered adequate to identify those with psychological distress or difficulties in daily living because of the fear of COVID-19. This cut-off score will contribute to mental health assessment during the COVID-19 pandemic.
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Affiliation(s)
- Haruhiko Midorikawa
- Department of Psychiatry, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba 305-8575, Japan
| | - Hirokazu Tachikawa
- Department of Disaster and Community Psychiatry, Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba 305-8575, Japan
| | - Miyuki Aiba
- Faculty of Human Sciences, Toyo Gakuen University, 1-26-3 Hongo, Bunkyo, Tokyo 113-0033, Japan
| | - Yuki Shiratori
- Department of Psychiatry, Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba 305-8575, Japan
| | - Daichi Sugawara
- Faculty of Human Sciences, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba 305-8575, Japan
| | - Naoaki Kawakami
- Faculty of Human Sciences, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba 305-8575, Japan
| | - Ryo Okubo
- Department of Neuropsychiatry, National Hospital Organization Obihiro Hospital, 18-2-16, Obihiro 080-8518, Japan
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka 541-8567, Japan
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10
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Cayo-Rojas C, Córdova-Limaylla N, Ladera-Castañeda M, Briceño-Vergel G, López-Gurreonero C, Castro-Mena M, Cornejo-Pinto A, Agramonte-Rosell R, Cervantes-Ganoza L. Psychological distress facing the COVID-19 pandemic in dental interns from the Peruvian capital: A cross-sectional study under a multivariable regression model. Front Public Health 2022; 10:996921. [PMID: 36620256 PMCID: PMC9811120 DOI: 10.3389/fpubh.2022.996921] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 11/24/2022] [Indexed: 12/24/2022] Open
Abstract
Aim Psychological distress can be considered a maladaptive response to a stressful situation that occurs when external events or stressors impose demands that cannot be coped with. Therefore, the aim of the present study was to evaluate the sociodemographic factors associated with psychological distress in dental interns from the Peruvian capital facing the COVID-19 pandemic. Materials and methods This analytical, observational, cross-sectional study was conducted on 392 Stomatology interns from the Peruvian capital from June to July 2022. The validated COVID-19 Peritraumatic Distress Index (CPDI) scale to detect the levels of psychological distress consisted of four dimensions: negative mood, changes in behavior and cognitive skills, fatigue and hyperreactivity, and somatization. Pearson's chi-square and Fisher's exact test were used for bivariable analysis. In addition, a logit model was used to assess the influence of variables: sex (X1), age group (X2), marital status (X3), monthly economic income (X4), working area in the capital city (X5), and living with people vulnerable to COVID-19 (X6), with the psychological distress levels, considering a significance p < 0.05. Results The prevalence of psychological distress in dental interns was severe in 6.4% [95% confidence interval (CI): 3.9-8.8%] and mild in 37.8% (95% CI: 33.0-42.6%). According to bivariable analysis, the levels of psychological distress by COVID-19 were not significantly associated with sex (p = 0.190), age group (p = 0.418), marital status (p = 0.554), monthly economic income (p = 0.327), working area in the capital city (p = 0.993), and living with people vulnerable to COVID-19 (p = 0.134). In addition, according to the logistic regression analysis, none of the variables studied was considered an influential factor (p > 0.05) in psychological distress presented by dental interns. Conclusion The 44.2% of dental interns from the Peruvian capital presented psychological distress facing the COVID-19 pandemic, without any of the possible associated variables of this study significantly affecting this behavioral disorder.
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Affiliation(s)
- César Cayo-Rojas
- School of Stomatology, Universidad Privada San Juan Bautista, Lima, Peru,*Correspondence: César Cayo-Rojas
| | | | - Marysela Ladera-Castañeda
- Faculty of Dentistry and Postgraduate School, Grupo de Investigación Salud y Bienestar Global, Universidad Nacional Federico Villarreal, Lima, Peru
| | | | | | - Manuel Castro-Mena
- School of Stomatology, Universidad Privada San Juan Bautista, Lima, Peru
| | - Alberto Cornejo-Pinto
- Faculty of Dentistry and Postgraduate School, Grupo de Investigación Salud y Bienestar Global, Universidad Nacional Federico Villarreal, Lima, Peru
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11
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Chiang C, Morita S, Hirakawa Y, Priya FT, Matsumoto Y, Ota A, Yatsuya H, Tabuchi T. Possible contribution of COVID-19 vaccination to the subsequent mental well-being in Japan. Sci Rep 2022; 12:21195. [PMID: 36477701 PMCID: PMC9729563 DOI: 10.1038/s41598-022-25357-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has had a severe impact on mental well-being. Vaccination may have played a pivotal role in enduring this mental health crisis. The present study aimed to longitudinally investigate the association between COVID-19 vaccination and mental health status among Japanese population in 2021. Longitudinal data of 17,089 individuals aged 15-79 years who participated in a nationwide online study were analyzed. Baseline and follow-up mental health statuses were assessed using the Kessler Psychological Distress Scale (K6). General linear and multivariable logistic regression models adjusted for baseline levels of mental distress were used to examine the association between vaccine receipt and follow-up levels of mental health. Mean K6 scores were lower in the vaccinated than in the non-vaccinated participants. Those who had received one or two doses of COVID-19 vaccines were associated with improved mental health at follow-up in subjects with psychological distress at baseline (odds ratio [OR] 1.31 and 1.35, respectively) and were inversely associated with deteriorated mental health status at follow-up in subjects without psychological distress at baseline (OR 0.66 and 0.70, respectively) compared with no vaccination groups, respectively. The present study would indicate that one or two doses of COVID-19 vaccinations contributed to mental well-being in Japan. This finding might provide evidence for promoting vaccination against COVID-19 and emerging infectious diseases in the future.
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Affiliation(s)
- Chifa Chiang
- grid.27476.300000 0001 0943 978XDepartment of Public Health and Health Systems, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-ku, Nagoya, Aichi 466-8550 Japan
| | - Shuhei Morita
- grid.27476.300000 0001 0943 978XNagoya University School of Medicine, 65 Tsurumai-Cho, Showa-ku, Nagoya, Aichi 466-8550 Japan
| | - Yoshihisa Hirakawa
- grid.27476.300000 0001 0943 978XDepartment of Public Health and Health Systems, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-ku, Nagoya, Aichi 466-8550 Japan
| | - Farzana Tanzin Priya
- grid.27476.300000 0001 0943 978XDepartment of Public Health and Health Systems, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-ku, Nagoya, Aichi 466-8550 Japan
| | - Yuka Matsumoto
- grid.27476.300000 0001 0943 978XNagoya University School of Medicine, 65 Tsurumai-Cho, Showa-ku, Nagoya, Aichi 466-8550 Japan
| | - Atsuhiko Ota
- grid.256115.40000 0004 1761 798XDepartment of Public Health, Fujita Health University School of Medicine, Toyoake, Aichi 470-1192 Japan
| | - Hiroshi Yatsuya
- grid.27476.300000 0001 0943 978XDepartment of Public Health and Health Systems, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-ku, Nagoya, Aichi 466-8550 Japan
| | - Takahiro Tabuchi
- grid.489169.b0000 0004 8511 4444Cancer Control Center, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka-shi, Osaka 541-8567 Japan
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Sasaki R, Ota A, Yatsuya H, Tabuchi T. Gender Difference in Fear and Anxiety about and Perceived Susceptibility to COVID-19 in the Third Wave of Pandemic among the Japanese General Population: A Nationwide Web-Based Cross-Sectional Survey. Int J Environ Res Public Health 2022; 19:16239. [PMID: 36498310 PMCID: PMC9738986 DOI: 10.3390/ijerph192316239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/28/2022] [Accepted: 11/30/2022] [Indexed: 06/17/2023]
Abstract
Existing research suggested gender differences in fear and anxiety about and perceived susceptibility to COVID-19 and previous infectious disease pandemics. We analyzed whether women felt fear and anxiety about and perceived susceptibility to COVID-19 more frequently than men in Japan. We conducted a cross-sectional analysis using internet survey data collected during the third wave of the pandemic in Japan. The subjects were enrolled from the Japanese general population: 11,957 men and 11,559 women. Fear and anxiety specifically related to COVID-19 were evaluated with the Japanese version of the Fear of COVID-19 Scale (FoCS). The question "How likely do you think you will be infected with COVID-19?" was used to assess the perceived susceptibility to COVID-19. Women had higher mean (standard deviation) FoCS scores [18.6 (5.6) vs. 17.5 (5.9), d = 0.190] and reported the median or higher FoCS score (57.4% vs. 51.4%, φ = 0.060) and perceived susceptibility (13.6% vs. 11.5%, φ = 0.032) more frequently than men. The odds ratios (95% confidence intervals) adjusted for age, having a spouse, comorbidities, watching commercial TV stations' news programs, employment status, and household income were 1.24 (1.17-1.32) and 1.27 (1.16-1.38), respectively. We observed that women were more anxious and fearful about and perceived the susceptibility to infectious diseases more frequently than men even one year after the pandemic occurred in Japan, although the effect size was small.
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Affiliation(s)
- Rio Sasaki
- Department of Public Health, Fujita Health University School of Medicine, Toyoake 470-1192, Japan
| | - Atsuhiko Ota
- Department of Public Health, Fujita Health University School of Medicine, Toyoake 470-1192, Japan
| | - Hiroshi Yatsuya
- Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Osaka 541-8567, Japan
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Shimamoto K, McElroy E, Ibuka Y. Health inequity in pandemic anxiety about COVID-19 infection and socioeconomic consequences in Japan: A structural equation modeling approach. SSM Popul Health 2022; 20:101269. [PMID: 36276239 PMCID: PMC9574575 DOI: 10.1016/j.ssmph.2022.101269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 09/30/2022] [Accepted: 10/11/2022] [Indexed: 11/28/2022] Open
Abstract
Background Health inequity in relation to COVID-19 infection and socioeconomic consequences is a major global concern. Mental health issues in vulnerable populations have received special attention in research and practice during the COVID-19 pandemic. However, there is limited evidence on the nature of the anxieties experienced as a result of COVID-19, and how such concerns vary across demographic groups. Aim This study examines anxiety among the working population of Japan (aged 18-59), in terms of both COVID-19 infection and socioeconomic consequences, using an internationally validated tool, the Pandemic Anxiety Scale (PAS). Methods Data were collected using an online survey (n = 2,764). The analyses included an exploratory factor analysis (EFA), a confirmatory factor analysis (CFA), and structural equation modeling (SEM), followed by validation of the Japanese version of the PAS. Results A two-factor latent variable model shows the multidimensionality of anxiety in regard to the COVID-19 pandemic and the disparity across population groups in predicting the two defined anxiety dimensions. Several path coefficients showed somewhat unexpected and/or unique results from Japan compared with previous European studies. Specifically, self-reported health status was not significantly related to disease anxiety, and those who were not in paid employment reported lower consequence anxiety. The SEM results showed a greater number of significant exogenous variables for consequence anxiety compared to disease anxiety, highlighting disparities in pandemic anxiety by socioeconomic status in regard to socioeconomic consequences of the pandemic. Conclusion In contrast to existing European studies, evidence from the current study suggests contextual patterns of health inequity. Due to the prolonged socioeconomic consequences of the pandemic, multidisciplinary research on mental health issues and the quality of life remains an important research agenda in exploring socioeconomic measures in context, towards addressing inequity concerns.
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Affiliation(s)
- Kyoko Shimamoto
- Keio Global Research Institute, Keio University, 2-15-45 Mita, Minato-ku, Tokyo, 108-8345, Japan,Graduate School of Health Management, Keio University, 35 Shinanomachi, Shinjyuku-ku, Tokyo, 160-8582, Japan,Corresponding author. Keio Global Research Institute, Keio University, 2-15-45 Mita, Minato-ku, Tokyo, 108-8345, Japan
| | - Eoin McElroy
- School of Psychology, Ulster University, Cromore Road, Coleraine, Co. Londonderry, BT52 1SA, United Kingdom
| | - Yoko Ibuka
- Department of Economics, Keio University, 2-15-45 Mita, Minato-ku, Tokyo, 108-8345, Japan
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Abe K, Daniunaite I, Truskauskaitė-kunevičienė I, Sugimura K, Zelviene P, Hihara S, Kamite Y, Kazlauskas E. Cross-Cultural Comparison of ICD-11 Adjustment Disorder Prevalence and Its Risk Factors in Japanese and Lithuanian Adolescents. Brain Sci 2022; 12:1172. [PMID: 36138907 PMCID: PMC9496776 DOI: 10.3390/brainsci12091172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 08/24/2022] [Accepted: 08/30/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Although there is increasing knowledge about adjustment disorder (AjD) based on the new diagnostic criteria of the International Classification of Diseases (ICD-11), less is known on AjD in adolescents. This study aimed to examine the prevalence of AjD and its risk factors in Japanese and Lithuanian adolescents. Methods: The cross-sectional study sample comprised 1745 adolescents from Japan (n = 913) and Lithuania (n = 832). AjD was assessed using the Adjustment Disorder New Module-8 (ADNM-8). We compared the prevalence of AjD in Japanese and Lithuanian adolescents. Using multinominal logistic regression analysis, we examined the effects of age, gender, socioeconomic status, and cumulative stressors as societal and cultural factors, resilience as an intrapersonal factor, and loneliness and perceived support as interpersonal factors on adolescent AjD. Results: The prevalence of probable AjD was 11.7% in Lithuanian adolescents and 6.9% in Japanese adolescents. Gender, socioeconomic status, cumulative stressors, resilience, loneliness, and perceived positive social support were each significantly associated with AjD risk. Conclusions: This cross-cultural comparative study revealed characteristics of the stressors and prevalence of AjD among Japanese and Lithuanian adolescents. In terms of the socio-interpersonal framework model for the stress–response syndrome, sociocultural, intrapersonal, and interpersonal factors were found to be risk factors associated with AjD in adolescents.
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Murayama K, Tatebayashi H, Kawaguchi T, Fujita K, Sashikata K, Nakao T. The Impact of Gender and Age Differences and Infectious Disease Symptoms on Psychological Distress in Quarantined Asymptomatic or Mildly Ill COVID-19 Patients in Japan. Int J Environ Res Public Health 2022; 19:ijerph19159083. [PMID: 35897455 PMCID: PMC9332173 DOI: 10.3390/ijerph19159083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/21/2022] [Accepted: 07/23/2022] [Indexed: 02/01/2023]
Abstract
Quarantine imposed due to COVID-19 infection can exacerbate psychological distress, and it is important for a public mental health agency to identify factors that are predictive of high psychological distress in such situation. The aim of this study was to investigate whether gender, age, and the presence or absence of infectious disease symptoms affected psychological distress among asymptomatic or mildly ill COVID-19 patients who were quarantined. Participants were 436 asymptomatic or mildly symptomatic COVID-19-infected patients who were quarantined in a treatment facility between 1 May 2020 and 30 September 2021. We used Quantification Theory I analysis to investigate the effects of gender, age, and the nature of infectious disease symptoms on psychological distress. The results of the analysis showed that the contribution rate was 0.06. Among gender, age, presence of symptoms, and the nature of symptoms, age had the greatest effect on psychological distress, and being in one’s teens to thirties was considered to exacerbate psychological distress the most. According to the results, the psychological distress of asymptomatic and mildly symptomatic COVID-19 patients isolated was affected by gender, age, and symptomology, especially due to age differences. However, the impact of these items on psychological distress was not considered significant.
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Affiliation(s)
- Keitaro Murayama
- Department of Neuropsychiatry, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka 8128582, Japan
- Correspondence:
| | | | - Takako Kawaguchi
- Fukuoka City Mental Health Welfare Center, 2-5-1 Maizuru, Chuo-ku, Fukuoka 8100073, Japan;
| | - Kousuke Fujita
- Kitakyushu Municipal Mental Health Welfare Center, 1-7-1 Basyaku, Kokurakita-ku, Kitakyushu 8020077, Japan;
| | - Kenta Sashikata
- Graduate School of Human-Environment Studies, Kyushu University, 744 Motooka, Nishi-ku, Fukuoka 8190395, Japan;
| | - Tomohiro Nakao
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 8128582, Japan;
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16
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Nakamoto I, Murayama H, Takase M, Muto Y, Saito T, Tabuchi T. Association between increased caregiver burden and severe psychological distress for informal caregivers during the COVID-19 pandemic in Japan: A cross-sectional study. Arch Gerontol Geriatr 2022; 102:104756. [PMID: 35779345 PMCID: PMC9214660 DOI: 10.1016/j.archger.2022.104756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 06/05/2022] [Accepted: 06/16/2022] [Indexed: 11/18/2022]
Abstract
Objective During the coronavirus disease 2019 (COVID-19) pandemic, informal caregivers’ mental health deteriorated more than that of non-caregivers. We examined the association between increased caregiver burden during the pandemic and severe psychological distress (SPD). Methods We used cross-sectional data from a nationwide internet survey conducted between August and September 2020 in Japan. Of 25,482 participants aged 15–79 years, 1,920 informal caregivers were included. SPD was defined as Kessler 6 Scale (K6) score ≥ 13. Self-rated change in caregiver burden was measured retrospectively with a single question item. Binary logistic regression analysis was used to examine the association between SPD and increased caregiver burden during the pandemic, adjusted for demographic, socioeconomic, health, and caregiving variables. To examine the differential association between increased caregiver burden and SPD, interaction terms were added and binary logistic regression was separately conducted for all variables. Results Participants’ mean age was 52.3 years (standard deviation 15.9), 48.8% of participants were male, 56.7% reported increased caregiver burden, and 19.3% exhibited SPD. Increased caregiver burden was significantly associated with SPD (adjusted odds ratio: 1.90; 95% confidence interval: 1.37–2.66). The association between increased caregiver burden and SPD was stronger among caregivers who were married, those undergoing disease treatment, and those with a care-receiver with a care need level of 1–2. Conclusions The results revealed that more than half of caregivers reported increased caregiver burden, and increased caregiver burden was associated with SPD during the pandemic. Measures supporting mental health for caregivers with increased caregiver burden should be implemented immediately.
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Affiliation(s)
- Isuzu Nakamoto
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Hiroshi Murayama
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan.
| | - Mai Takase
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Yoko Muto
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Tami Saito
- Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
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Abstract
OBJECTIVES The detrimental impacts of abuse on victims' well-being are well documented globally, including Japan. The ongoing COVID-19 pandemic may increase the incidence of abuse in the community, creating an additional burden amid the crisis. However, the incidence of abuse in Japan during COVID-19 remains to be evaluated. Accordingly, our study aimed to assess the incidence of physical and verbal abuse among the general population in Japan and to identify the associated factors of abuse during COVID-19. DESIGN AND SETTING We used the data obtained from a nationwide, cross-sectional internet survey conducted in Japan between August and September 2020. Sampling weights were used to calculate national estimates, and multivariable logistic regression was performed to identify the associated factors for physical and verbal abuse. RESULTS Out of the total 25 482 participants, 965 (3.8 %) reported experiencing physical abuse and 1941 (7.6%) verbal abuse from April 2020 to September 2020. The incidence of physical and verbal abuse was higher among female participants. Participants who lived in areas where the 'state of emergency' was enforced were more likely to suffer from physical abuse. Similarly, vulnerable participants such as those below age 18, with low income, bad family relationships, and disabled people were more likely to experience both physical and verbal abuse. Participants suffering from COVID-19-related symptoms, who had poor health status and widows/divorcees were more likely to be verbally abused. Furthermore, those who did not follow preventive behaviours such as wearing masks in public places, abusing drugs and drinking alcohol in high amounts were also more likely to experience abuse. CONCLUSION The impact of abuse was found disproportionately greater in more vulnerable groups of the population. Pandemic has reinforced the existing social inequalities, which need to be addressed timely to prevent precarious repercussions.
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Affiliation(s)
| | - Akihiko Ozaki
- Medical Governance Research Institute, Tokyo, Japan
- Department of Breast Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki, Japan
| | - Tomoya Suzuki
- Medical Governance Research Institute, Tokyo, Japan
- School of Medicine, Akita University, Akita, Japan
| | - Yasuhiro Kotera
- School of Health Science, University of Nottingham, Nottingham, UK
| | - Sunil Shrestha
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Sayaka Horiuchi
- Center for Birth Cohort Studies, University of Yamanashi, Yamanashi, Japan
| | - Takashi Miyachi
- Medical Governance Research Institute, Tokyo, Japan
- School of Medicine, Akita University, Akita, Japan
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
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Abstract
IMPORTANCE Although the suicide rate in Japan increased during the COVID-19 pandemic, the reasons for suicide have yet to be comprehensively investigated. OBJECTIVE To assess which reasons for suicide had rates that exceeded the expected number of suicide deaths for that reason during the COVID-19 pandemic. DESIGN, SETTING, AND PARTICIPANTS This national, population-based cross-sectional study of data on suicides gathered by the Ministry of Health, Labor, and Welfare from January 2020 to May 2021 used a times-series analysis on the numbers of reason-identified suicides. Data of decedents were recorded by the National Police Agency and compiled by the Ministry of Health, Labor, and Welfare. EXPOSURE For category analysis, we compared data from January 2020 to May 2021 with data from December 2014 to June 2020. For subcategory analysis, data from January 2020 to May 2021 were compared with data from January 2019 to June 2020. MAIN OUTCOMES AND MEASURES The main outcome was the monthly excess suicide rate, ie, the difference between the observed number of monthly suicide deaths and the upper bound of the 1-sided 95% CI for the expected number of suicide deaths in that month. Reasons for suicide were categorized into family, health, economy, work, relationships, school, and others, which were further divided into 52 subcategories. A quasi-Poisson regression model was used to estimate the expected number of monthly suicides. Individual regression models were used for each of the 7 categories, 52 subcategories, men, women, and both genders. RESULTS From the 29 938 suicides (9984 [33.3%] women; 1093 [3.7%] aged <20 years; 3147 [10.5%] aged >80 years), there were 21 027 reason-identified suicides (7415 [35.3%] women). For both genders, all categories indicated monthly excess suicide rates, except for school in men. October 2020 had the highest excess suicide rates for all cases (observed, 1577; upper bound of 95% CI for expected number of suicides, 1254; 25.8% greater). In men, the highest monthly excess suicide rate was 24.3% for the other category in August 2020 (observed, 87; upper bound of 95% CI for expected number, 70); in women, it was 85.7% for school in August 2020 (observed, 26; upper bound of 95% CI for expected number, 14). CONCLUSIONS AND RELEVANCE In this study, observed suicides corresponding to all 7 categories of reasons exceeded the monthly estimates (based on data from before or during the COVID-19 pandemic), except for school-related reasons in men. This study can be used as a basis for developing intervention programs for suicide prevention.
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Affiliation(s)
- Masahide Koda
- Department of Psychiatry, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Nahoko Harada
- Department of Psychiatric and Mental Health Nursing, School of Nursing, University of Miyazaki, Miyazaki, Japan
| | - Akifumi Eguchi
- Department of Sustainable Health Science, Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
| | - Shuhei Nomura
- Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Tokyo Foundation for Policy Research, Tokyo, Japan
| | - Yasushi Ishida
- Department of Psychiatry, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
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Kodama T, Ishimaru T, Tateishi S, Hino A, Tsuji M, Ogami A, Nagata T, Matsuda S, Fujino Y. Effect of working place infection control practices on workers' psychological distress: A large-scale cohort study during the COVID-19 pandemic in Japan. Front Psychiatry 2022; 13:933556. [PMID: 36186858 PMCID: PMC9523011 DOI: 10.3389/fpsyt.2022.933556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 08/22/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has dramatically transformed the work environment and practices worldwide. Long-term infection control practices may increase the psychological distress of workers, and, conversely, inadequate infection control practices in the working place may increase the fear of infection. This study aimed to determine the relationship between infection control practices in the working place and employee mental state during the COVID-19 pandemic in Japan. METHODS This study was conducted in December 2020 and February 2021. The participants had undergone a preliminary survey, which revealed that they were in a good mental state. Their psychological distress was investigated via a second survey, and the factors associated with distress were studied using a logistic model. RESULTS The results of the second survey indicated that 15.3% of participants demonstrated psychological distress. This was associated with leave-of-absence instructions, instructions for shortening business hours, and requests to avoid the working place in case of any symptoms. CONCLUSION The study found that while some infection control practices reduce workers' distress, others worsen it. Employers need to consider infection control practices as well as the worsening mental state of employees following a decrease in income caused by such measures. Follow-up studies may be necessary to clarify the long-term effects on workers' mental states.
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Affiliation(s)
- Toyohiko Kodama
- Department of Nursing, School of Health Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Tomohiro Ishimaru
- Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Seiichiro Tateishi
- Department of Occupational Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Ayako Hino
- Department of Mental Health, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Mayumi Tsuji
- Department of Environmental Health, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Akira Ogami
- Department of Work Systems and Health, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Tomohisa Nagata
- Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Shinya Matsuda
- Department of Public Health, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yoshihisa Fujino
- Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan
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20
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Takeda T, Yoshimi K, Kai S, Inoue F. Association Between Serious Psychological Distress and Loneliness During the COVID-19 Pandemic: A Cross-Sectional Study with Pregnant Japanese Women. Int J Womens Health 2021; 13:1087-1093. [PMID: 34795535 PMCID: PMC8593838 DOI: 10.2147/ijwh.s338596] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 11/03/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose Pregnant women are vulnerable to stress. The coronavirus disease 2019 (COVID-19) has caused a global pandemic and created significant stress for many people. Social distancing to reduce the spread of COVID-19 has also reduced social interactions, which has increased social isolation and loneliness. Loneliness is thought to increase perceived stress, cause psychological distress, and increase the risk of mental illness, such as depression. This study examined the association between serious psychological distress (SPD) and loneliness during the COVID-19 pandemic in pregnant Japanese women. Patients and Methods An internet survey of 1022 pregnant women in Japan was conducted between June 1 and July 21, 2021. The 6-item Kessler Psychological Distress Scale, 3-item Revised UCLA Loneliness Scale, and Fear of COVID-19 Scale were used as measurement tools. The prevalence of SPD was defined as a K6 score of ≥13. Results The prevalence of SPD was 16.5%. Multivariate analysis revealed that the risk factors for SPD were younger age (odds ratio [OR] 1.05; 95% confidence interval [CI] 1.01 to 1.10; p = 0.020), history of abortion or miscarriages (OR 1.56; 95% CI 1.04 to 2.36; p = 0.034), unemployment (OR 1.67; 95% CI 1.14 to 2.45; p = 0.008), fear of COVID-19 (OR, 1.12; 95% CI, 1.08 to 1.17; p < 0.001), and loneliness (OR 1.53; 95% CI 1.38 to 1.70; p < 0.001). Conclusion Pregnant women in Japan showed a high prevalence of SPD. Younger age, unemployment, history of abortion or miscarriages, fear of COVID-19, and loneliness were independently associated with SPD. Clinicians and health officials should pay particular attention to the psychological health of pregnant women during the COVID-19 pandemic.
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Affiliation(s)
- Takashi Takeda
- Division of Women's Health, Research Institute of Traditional Asian Medicine, Kindai University, Osaka, 589-8511, Japan
| | - Kana Yoshimi
- Division of Women's Health, Research Institute of Traditional Asian Medicine, Kindai University, Osaka, 589-8511, Japan
| | - Sayaka Kai
- Division of Women's Health, Research Institute of Traditional Asian Medicine, Kindai University, Osaka, 589-8511, Japan
| | - Fumi Inoue
- Division of Women's Health, Research Institute of Traditional Asian Medicine, Kindai University, Osaka, 589-8511, Japan
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21
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Di Blasi M, Albano G, Bassi G, Mancinelli E, Giordano C, Mazzeschi C, Pazzagli C, Salcuni S, Lo Coco G, Gelo OCG, Lagetto G, Freda MF, Esposito G, Caci B, Merenda A, Salerno L. Factors Related to Women's Psychological Distress during the COVID-19 Pandemic: Evidence from a Two-Wave Longitudinal Study. Int J Environ Res Public Health 2021; 18:11656. [PMID: 34770172 PMCID: PMC8583639 DOI: 10.3390/ijerph182111656] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/03/2021] [Accepted: 11/04/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND A growing body of research has highlighted the negative effects of the COVID-19 pandemic on women's mental health. Previous studies showed that women have higher levels of depression, anxiety and PTSD, and worse psychological adjustment than men, which also persisted after the earlier phase of the pandemic. This study aimed to evaluate changes in women's psychological distress during the pandemic and to evaluate the factors that have a more significant impact in predicting women's psychological distress. METHODS This two-wave longitudinal study (T1 = Italian first lockdown, and T2 = second phase, when the restrictive measures were eased) involved 893 women (Mage = 36.45, SD = 14.48). Participants provided demographic and health data as well as measures of psychological distress, emotion regulation processes, and ability to tolerate uncertainty. RESULTS No significant changes were found in women's psychological distress between T1 and T2, i.e., during and after the first lockdown. Lower social stability status and higher maladaptive emotional coping predicted high psychological distress. CONCLUSIONS Results showed that modifiable psychological variables play a central role in predicting distress and indicated that emotion regulation interventions might be helpful in increasing psychological resilience and mitigating the adverse impacts of the COVID-19 pandemic within the female population.
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Affiliation(s)
- Maria Di Blasi
- Department of Psychology, Educational Science and Human Movement, University of Palermo, 90128 Palermo, Italy; (C.G.); (G.L.C.); (B.C.); (A.M.); (L.S.)
| | - Gaia Albano
- Department of Psychology, Educational Science and Human Movement, University of Palermo, 90128 Palermo, Italy; (C.G.); (G.L.C.); (B.C.); (A.M.); (L.S.)
| | - Giulia Bassi
- Department of Developmental and Social Psychology, University of Padova, 35132 Padova, Italy; (G.B.); (E.M.); (S.S.)
- Digital Health Lab, Fondazione Bruno Kessler, 38122 Trento, Italy
| | - Elisa Mancinelli
- Department of Developmental and Social Psychology, University of Padova, 35132 Padova, Italy; (G.B.); (E.M.); (S.S.)
- Digital Health Lab, Fondazione Bruno Kessler, 38122 Trento, Italy
| | - Cecilia Giordano
- Department of Psychology, Educational Science and Human Movement, University of Palermo, 90128 Palermo, Italy; (C.G.); (G.L.C.); (B.C.); (A.M.); (L.S.)
| | - Claudia Mazzeschi
- Department of Philosophy, Social & Human Sciences and Education, University of Perugia, 06123 Perugia, Italy; (C.M.); (C.P.)
| | - Chiara Pazzagli
- Department of Philosophy, Social & Human Sciences and Education, University of Perugia, 06123 Perugia, Italy; (C.M.); (C.P.)
| | - Silvia Salcuni
- Department of Developmental and Social Psychology, University of Padova, 35132 Padova, Italy; (G.B.); (E.M.); (S.S.)
| | - Gianluca Lo Coco
- Department of Psychology, Educational Science and Human Movement, University of Palermo, 90128 Palermo, Italy; (C.G.); (G.L.C.); (B.C.); (A.M.); (L.S.)
| | - Omar Carlo Gioacchino Gelo
- Department of History, Society and Human Studies, University of Salento, 73100 Lecce, Italy; (O.C.G.G.); (G.L.)
- Faculty of Psychotherapy Science, Sigmund Freud University Vienna, 1020 Vienna, Austria
| | - Gloria Lagetto
- Department of History, Society and Human Studies, University of Salento, 73100 Lecce, Italy; (O.C.G.G.); (G.L.)
| | - Maria Francesca Freda
- Department of Humanities, University of Napoli Federico II, 80133 Napoli, Italy; (M.F.F.); (G.E.)
| | - Giovanna Esposito
- Department of Humanities, University of Napoli Federico II, 80133 Napoli, Italy; (M.F.F.); (G.E.)
| | - Barbara Caci
- Department of Psychology, Educational Science and Human Movement, University of Palermo, 90128 Palermo, Italy; (C.G.); (G.L.C.); (B.C.); (A.M.); (L.S.)
| | - Aluette Merenda
- Department of Psychology, Educational Science and Human Movement, University of Palermo, 90128 Palermo, Italy; (C.G.); (G.L.C.); (B.C.); (A.M.); (L.S.)
| | - Laura Salerno
- Department of Psychology, Educational Science and Human Movement, University of Palermo, 90128 Palermo, Italy; (C.G.); (G.L.C.); (B.C.); (A.M.); (L.S.)
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22
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Eguchi H, Hino A, Inoue A, Tsuji M, Tateishi S, Ando H, Nagata T, Matsuda S, Fujino Y. Effect of Anxiety About COVID-19 Infection in the Workplace on the Association Between Job Demands and Psychological Distress. Front Public Health 2021; 9:722071. [PMID: 34722436 PMCID: PMC8548681 DOI: 10.3389/fpubh.2021.722071] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 09/09/2021] [Indexed: 12/19/2022] Open
Abstract
Purpose: There is limited information about the association between workplace psychosocial factors and general worker mental health status during the COVID-19 pandemic. In the present study, we examined how anxiety about being infected by COVID-19 in the workplace affected the association between job demands and psychological distress (PD). Method: A cross-sectional online survey was conducted in December 2020. The final analyzed sample was 27,036. The dependent variable of PD was assessed using the Kessler Psychological Distress Scale (K6). Job demands were assessed using the Job Content Questionnaire. Feelings of anxiety were assessed by participants' responses to the following question: “Do you feel anxiety about being infected by COVID-19 in the workplace?” We used a two-level regression adjusting for prefectural level: each individual-level variable at level 1 was nested into each prefecture at level 2, stratified by presence of anxiety. Results: A total of 50.5% of participants felt anxious about being infected by COVID-19 in the workplace. The interaction between anxiety and job demands was significant. Job demands were positively associated with PD. In the stratified analysis, the associations were stronger among employees who experienced anxiety about COVID-19 infection in the workplace than among those who did not. Conclusion: The association between job demands and PD may be strengthened by anxiety about COVID-19 infection in the workplace.
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Affiliation(s)
- Hisashi Eguchi
- Department of Mental Health, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Ayako Hino
- Department of Mental Health, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Akiomi Inoue
- Institutional Research Center, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Mayumi Tsuji
- Department of Environmental Health, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Seiichiro Tateishi
- Department of Occupational Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Hajime Ando
- Department of Work Systems and Health, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Tomohisa Nagata
- Department of Occupational Health Practice and Management, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Shinya Matsuda
- Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Yoshihisa Fujino
- Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
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23
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Indu PV, Vijayan B, Tharayil HM, Ayirolimeethal A, Vidyadharan V. Domestic violence and psychological problems in married women during COVID-19 pandemic and lockdown: A community-based survey. Asian J Psychiatr 2021; 64:102812. [PMID: 34461369 PMCID: PMC8514844 DOI: 10.1016/j.ajp.2021.102812] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 08/05/2021] [Accepted: 08/09/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Following the declaration of Coronavirus disease-2019 as a pandemic, a nation-wide lockdown was announced in India. This led to increase in psychological problems, especially in women. OBJECTIVES To assess the prevalence of psychological problems and domestic violence (DV) in married women during the pandemic and lockdown in a panchayat in Southern India and to study the association of socio-demographic and clinical variables with psychological problems. MATERIALS AND METHODS A cross-sectional study was undertaken in 209 married women of 18-55 years residing in a village panchayat of northern Kerala, India. Socio-demographic variables and clinical variables, like depressive symptoms, anxiety symptoms, perceived stress and DV, among others, were evaluated. The participants were interviewed by trained community health workers in the post-lockdown period. RESULTS The prevalence of depressive symptoms was found to be 10.0 %, anxiety symptoms 7.2 % and perceived stress 66.0 %. Severe DV was reported by 6.2 %; but at least one form of DV was experienced by 25.8 % of the women. Significant positive correlation was observed for DV with depression and anxiety. DV was also found to be a significant predictor of depression (adjusted OR [aOR] = 4.26, P = 0.006) and anxiety (aOR=4.34, P=0.02). Being a homemaker (aOR=4.51, P = 0.03) and having past history of mental illness (aOR=5.39, P = 0.03) were also found to increase the risk for depression significantly. CONCLUSION There is a high prevalence of psychological problems in married women during the pandemic and lockdown. DV was found to be a significant predictor of depression and anxiety in this population.
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Affiliation(s)
| | - Binsu Vijayan
- Medical College Hospital Unit, Cheroopa, Department of Community Medicine, Government Medical College, Kozhikode, Kerala, 673008, India.
| | - Harish M Tharayil
- Department of Psychiatry, Government Medical College, Kozhikode, Kerala, 673008, India.
| | | | - Varsha Vidyadharan
- Department of Psychiatry, Government Medical College, Kozhikode, Kerala, 673008, India.
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24
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Taniguchi Y, Miyawaki A, Tsugawa Y, Murayama H, Tamiya N, Tabuchi T. Family caregiving and changes in mental health status in Japan during the COVID-19 pandemic. Arch Gerontol Geriatr 2022; 98:104531. [PMID: 34563936 DOI: 10.1016/j.archger.2021.104531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 09/10/2021] [Accepted: 09/15/2021] [Indexed: 11/24/2022]
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has had a widespread significant impact on mental health. However, the effect of providing care to family members (informal caregiving) on changes in mental health status during the pandemic remains unclear. Methods Using cross-sectional data from a large internet survey conducted between August and September 2020, we investigated the association of informal caregiving status with the incidence of mental health deterioration (increased loneliness, self-reported deterioration in mental health, and new suicidal ideation) in Japan during the COVID-19 pandemic. Results Among 25,482 participants (mean age 48.8 [standard deviation 17.3]; 50.3% women), 2,500 (9.8%) were providing informal care during the pandemic. After adjusting for potential confounders, informal caregivers were more likely than non-caregivers to experience increased loneliness (adjusted odds ratio [aOR] 2.16; 95% confidence interval [CI] 1.70–2.76), self-reported deterioration in mental health (aOR 1.54; 95% CI 1.14–2.08), and new incidence of suicidal ideation (aOR 3.65; 95% CI 1.92–6.92). The degree of mental health deterioration depended on the intensity of care. For example, the incidence rates of new suicidal ideation were 15.0%, 5.2%, and 3.6% for individuals who provided high-intensity caregiving, those who provided low-intensity caregiving, and non-caregivers, respectively (p-for-trend<0.001). The stratified analysis by gender showed that informal caregiving was associated with self-reported deterioration in mental health status among women (aOR 2.19; 95% CI 1.49–3.21) but not men (aOR 1.08; 95% CI 0.75–1.56). Conclusion Informal caregivers were more likely to experience mental health deterioration than non-caregivers during the COVID-19 pandemic.
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25
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Okubo R, Yoshioka T, Ohfuji S, Matsuo T, Tabuchi T. COVID-19 Vaccine Hesitancy and Its Associated Factors in Japan. Vaccines (Basel) 2021; 9:vaccines9060662. [PMID: 34204465 PMCID: PMC8234307 DOI: 10.3390/vaccines9060662] [Citation(s) in RCA: 95] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/11/2021] [Accepted: 06/14/2021] [Indexed: 02/07/2023] Open
Abstract
The vaccine confidence index in Japan is one of the lowest worldwide. This study aimed to examine the proportion of COVID-19 vaccine hesitancy in the Japanese population using a larger sample and more robust statistical methods than previously, and to identify factors associated with vaccine hesitancy. We conducted a nationwide, cross-sectional Internet survey on 8–26 February 2021, and calculated the proportion and odds ratios for vaccine hesitancy. Among 23,142 responses analyzed, the proportion of COVID-19 vaccine hesitancy was 11.3% (10.9–11.7%). The proportion was higher among younger respondents and female respondents, and especially among younger female respondents (15.6%) compared with the lowest proportion among older male respondents (4.8%). The most cited reason for not getting vaccinated was concerns about adverse reactions in more than 70% of the respondents. The proportion of COVID-19 vaccine hesitancy in Japan was comparable to that in previous studies overseas, and the proportion among younger respondents was more than double that among older respondents. Factors associated with the hesitancy were female sex, living alone, low socioeconomic status, and presence of severe psychological distress, especially among older respondents. Thus, adequate measures should be taken to ensure that vaccines are delivered to people with these factors.
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Affiliation(s)
- Ryo Okubo
- Department of Clinical Epidemiology, Translational Medical Center, National Center of Neurology and Psychiatry, Tokyo 187-8551, Japan
- Correspondence: ; Tel.: +81-42-341-2712 (ext. 5843)
| | - Takashi Yoshioka
- Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Fukushima 960-1295, Japan;
| | - Satoko Ohfuji
- Department of Public Health, Graduate School of Medicine, Osaka City University, Osaka 545-8585, Japan;
| | - Takahiro Matsuo
- Division of Infectious Diseases, St. Luke’s International Hospital, Tokyo 104-8560, Japan;
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Osaka 541-8567, Japan;
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