Factors associated with serious psychological distress during the COVID-19 pandemic in Japan: a nationwide cross-sectional internet-based study

Abstract

To investigate the factors associated with serious psychological distress (SPD) during the COVID-19 pandemic in Japan.

Design

Nationwide cross-sectional study using survey data.

Setting

Internet survey using sampling weights for national estimates conducted between 25 August and 30 September 2020 in Japan.

Exposures

Demographics (age, gender), socioeconomic status (income level, employment type, educational attainment, marital status, family composition and caregiving burden); the experience of domestic violence (DV), the state of emergency and fear of and stigma related to COVID-19.

Main outcome measures

Prevalence of SPD, defined as Kessler 6 Scale score ≥13.

Results

Among 25 482 respondents, 10.0% met the criteria of SPD. Overall, women (adjusted OR (aOR) 1.59; 95% CI 1.17 to 2.16; p=0.003), ages 15–29 (aOR 2.35 compared with ages 45–59 years; 95% CI 1.64 to 3.38; p<0.001), low-income level (aOR 1.70 compared with intermediate income; 95% CI 1.16 to 2.49; p=0.007), providing caregiving to family members (aOR 5.48; 95% CI 3.51 to 8.56; p<0.001), experiencing DV (aOR 5.72; 95% CI 3.81 to 8.59; p<0.001) and fear of COVID-19 (aOR 1.96; 95% CI 1.55 to 2.48; p<0.001) were associated with SPD. Among women aged 15–29 years, who have a higher risk of suicide during the COVID-19 pandemic in Japan, caregiving, DV, fear of COVID-19 and COVID-19-related stigma were associated with SPD.

Conclusions

Economic situation, caregiving burden, DV and fear of COVID-19 were independently associated with SPD during the COVID-19 pandemic. Among young women, similar factors, except economic situation, were associated with SPD. Targeted interventions based on age and gender may be more effective in mitigating the negative impact of the COVID-19 pandemic on the population’s mental health.

SciScore for 10.1101/2021.02.27.21252458: (What is this?)

Please note, not all rigor criteria are appropriate for all manuscripts.

Table 1: Rigor

Institutional Review Board Statement	Consent: We obtained web-based informed consent from all respondents. IRB: The Institutional Review Board of Osaka International Cancer Institute approved this study (No. 20084).
Randomization	not detected.
Blinding	not detected.
Power Analysis	not detected.
Sex as a biological variable	To characterize the risk factors for young women in addition to the general public, we also conducted multivariable logistic regression analysis focusing on women aged 15–29 years whom prior reports have shown a dramatic increase in the suicide rate in Japan during the COVID-19 pandemic 6 Regarding this analysis, some comorbidities (hypertension, diabetes, COPD, cardiovascular disease, stroke, cancer) were uncommon among young women, and therefore, were not included as adjustment variables.

Table 2: Resources

Software and Algorithms
Sentences	Resources
The data were analyzed using STATA version 16.1 (Stata Corp., College Station, TX, USA).	STATA suggested: (Stata, RRID:SCR_012763)

Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:

Our study has limitations. First, because this survey was conducted between August and September 2020, it is possible that our findings would have been different if more recent data had been used. However, the data was collected just before October, 2020, when suicides among young women actually increased in Japan,41 and therefore, our findings may reflect the most critical period regarding the underlying reasons for increased suicide rates in Japan. Second, due to the self-reported design of our study, not all the variables were based on the validated questionnaire. For example, COVID-19-related stigma, which was an important risk factor for SPD among young women, was collected via a single-item questionnaire we developed, resulting in a lack of detailed stigma profiles.42 However, our survey used the items (K-6 scale), the reliability and validity of which have been tested and verified in prior studies.31,43 Third, given that our data were collected using an internet-based survey, respondents may be different in meaningful ways than those who were not recruited. However, we used propensity-score weighted analysis to adjust for the demographic, socio-economic, and health-related differences between respondents of the present study and the Japanese general public.33,34 Finally, our findings may not be generalizable to populations in other countries. Using large-scale, nationally representative survey data, we identified several important factors associated with SPD during the...

Results from TrialIdentifier: No clinical trial numbers were referenced.

Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

Results from JetFighter: We did not find any issues relating to colormaps.

Results from rtransparent:

Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
Thank you for including a protocol registration statement.

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