[Experience, user satisfaction, and difficulties of online occupational health consultations during the COVID-19 pandemic: A cross-sectional survey of workers in Japan].

OBJECTIVES: COVID-19 has led to an increased use of online consultations in occupational health. We examined experience, satisfaction, and difficulties with online consultations during the first year after the COVID-19 pandemic by surveying a sample of workers. METHODS: An online survey was conducted in March 2021 among full-time employees of an online panel survey (E-COCO-J: The Employee Cohort Study on the COVID-19 Pandemic in Japan). Respondents were asked to report whether they had online or face-to-face consultations with occupational health professionals in the past year, their level of satisfaction, and their difficulties and problems related to the online consultations. RESULTS: Of the 1,153 respondents, 1,102 (excluding those who were unemployed or on leave) were included in the analysis. Fifty respondents had had online consultations in the past year and 57 had face-to-face consultations. The proportion of respondents who reported satisfaction with online consultations was high (more than 70%) for general health, follow-ups, and guidance consultations, among others. However, the proportion of satisfaction with online occupational consultations was low (less than 40%) for employees who worked long hours, or took leave or returned to work. Over 30% of the respondents indicated that the difficulties with online consultations were due to incongruence with their expectations ("I preferred a face-to-face consultation instead of an online one"), quality of communication ("I did not feel like I was able to consult sufficiently"), and concerns about confidentiality ("I was worried that someone could hear our conversation"). CONCLUSION: The experience of online consultations was similar to that of face-to-face consultations. Satisfaction with online occupational consultations for those who worked long hours and those who took leave or returned to work was low. In the online consultation for occupational health, the occupational health professional may be required to judge its suitability depending on type of the consultation and take necessary consideration and measures to maintain the quality of the online consultation.

The effect of job strain and worksite social support on reported adverse reactions of COVID-19 vaccine: A prospective study of employees in Japan.

OBJECTIVES: This prospective study aimed to examine the association of psychosocial working conditions with adverse reactions after receiving COVID-19 vaccination in a sample of employees in Japan. METHODS: The data were retrieved from an online panel of full-time employees (E-COCO-J). The analysis included participants who were employed and were not vaccinated at baseline (June 2021) but received vaccination at a 4-month follow-up (October 2021). An 11-item scale measured the adverse reactions. Four types of psychosocial working conditions (i.e., job demands, job control, and supervisor and coworker support) were measured using the Brief Job Stress Questionnaire. Multiple linear regression analyses were conducted to examine the relationship between the psychosocial working conditions and adverse reactions of COVID-19 vaccines, adjusting for socioeconomic variables, chronic disease, the number of vaccination, type of vaccine, anxiety for adverse reactions, fear and worry about COVID-19, and psychological distress at baseline. RESULTS: Overall, 747 employees were included in the analysis. The average number of adverse reactions was 3.8 (standard deviation = 2.2): Arm pain (81.1%), fatigues (64.1%), muscle pains (63.3%), and fever (37.5°C+) (53.5%) were reported more frequently. Coworker support score was significantly and negatively associated with the numbers of adverse reactions (standardized ß = -0.100, P = .023). Women, young age, second-time vaccination, Moderna, and high psychological distress were significantly associated with adverse reactions. CONCLUSIONS: Employees with low coworker support may be more likely to have adverse reactions after vaccinations. The findings of this study could support that increasing workplace support may reduce adverse reactions.

COVID-19-Related Workplace Bullying and Customer Harassment Among Healthcare Workers Over the Time of the COVID-19 Outbreak: A Eight-Month Panel Study of Full-Time Employees in Japan.

OBJECTIVE: To investigate the prevalences of COVID-19-related workplace bullying and harassment (WBH) and customer harassment among healthcare workers (HCWs) compared to non-HCWs during COVID-19 outbreaks. METHODS: A baseline (March 2020) and follow-up surveys (May, August, and November 2020) were conducted of full-time employees, with an online questionnaire that included items on COVID-19-related WBH and customer harassment. The prevalences were compared between HCWs and non-HCWs using generalized linear models with repeated measures. RESULTS: A total of 800 (56%) respondents completed all the surveys. Prevalences of WBH and customer harassment were 5% to 10% and 10% to 13%, respectively, among HCWs during the follow-up. HCWs had a significantly higher prevalence of WBH in May (Adjusted OR = 2.3) and customer harassment in November (Adjusted OR = 2.7), compared to non- HCWs. CONCLUSIONS: HCWs remained at high risk of COVID-19-related WBH and customer harassment during the pandemic.

Effects of workplace measures against COVID-19 on psychological distress of full-time employees: A 12-month prospective study in the COVID-19 pandemic.

OBJECTIVE: This study aimed to investigate the prospective effects of corporate and organizational workplace measures against COVID-19 on reducing employees` psychological distress during a 12-month follow-up in the COVID-19 pandemic. METHODS: Data were retrieved from an online longitudinal panel survey of full-time employees in Japan, with the 1st survey in March 2020, and the 2nd to 6th surveys in May, August, November 2020, February and March 2021, respectively. Seven area-specific workplace measures were assessed using a self-report 23-item scale at the 2nd follow-up. Psychological distress was measured using an 18-item scale of the Brief Job Stress Questionnaire at each survey. Linear regressions and mixed model analysis were conducted of psychological distress at follow-ups on scores of the area-specific workplace measures, adjusting for psychological distress and other covariates at the 1st survey. RESULTS: A total of 941 employees responded at baseline; most of them (86.9-90.9%) participated in the follow-up surveys. Linear regression analysis indicated that workplace measures of facilitating employees' preventive measures (ie, hygiene behaviors) statistically significantly and negatively correlated with psychological distress at the 5th survey [b=-0.518, standard error (SE) 0.259, P=0.046]. A statistically significant and negative interaction between the scores and time of follow-up was observed in the mixed model analysis (b=-0.096, SE 0.047, P=0.041). No such correlation or interaction was found for any of other subcategorical workplace measures. CONCLUSIONS: The study provides prospective evidence for a protective effect of workplace measures to facilitate employee's hygiene behaviors on reducing psychological distress of full-time employees in the COVID-19 pandemic. The association seems stronger at a later follow-up.

Effects of workplace measures against COVID-19 and employees' worry about them on the onset of major depressive episodes: A 13-month prospective study of full-time employees.

BACKGROUND: Workplace measures against COVID-19 may prevent the onset of major depressive episode (MDE) in the working population. This 13-month prospective study aimed to investigate the association of the number of workplace measures against COVID-19 and employees' worry about the measures on the onset of MDE during COVID-19 outbreaks in Japan. METHODS: Data were collected from employees by using online questionnaires at baseline (May 2020) and the 7th survey (June 2021). The onset of MDE during the follow-up was retrospectively measured at the 7th survey, with a self-report scale based on the Mini-International Neuropsychiatric Interview according to the DSM-IV/DSM-5 criteria. Participants were asked to report the number of workplace measures against COVID-19 in their companies/organizations and their worry about these measures (scored 0-3). Multiple logistic regression was conducted of MDE on the number of workplace measures and worry about these, adjusting for demographic and work-related covariates and psychological distress at baseline. RESULTS: Among 968 respondents employed in May 2020, 827 completed the 7th survey in June 2021 (80%). We excluded 75 respondents who reported they had an MDE in May 2020 or earlier. Worry about workplace measures was significantly associated with the onset of MDE after adjusting for the covariates (OR for 1 score increase, 1.53; 95% CI, 1.02-2.32; p = 0.042). No significant association was found between the number of workplace measures and the onset of MDE. CONCLUSIONS: Worrying about workplace measures taken by company/organization may be a risk factor for the onset of an MDE among employees during the COVID-19 pandemic.

COVID-19 vaccination did not improve employee mental health: A prospective study in an early phase of vaccination in Japan.

OBJECTIVES: This study aimed to examine the effectiveness of vaccination to improve mental health among employees in Japan based on a prospective study. METHODS: The data were retrieved from the Employee Cohort Study conducted during the COVID-19 pandemic in Japan (E- COCO-J) at T1 (4-10 February 2021) and T2 (22-29 June 2021). Psychological distress was measured by using an 18-item scale of the Brief Job Stress Questionnaire (BJSQ). The analytic sample was limited to individuals employed at both T1 and T2 without missing covariates. Vaccination status was measured at T2. Statistical analysis was conducted to test the differential change in the psychological distress at T1 and T2 with the time × group interactions by using repeated ANOVA, adjusting for the covariates (gender, age, marital status, education, chronic disease, company size, industry, and occupation). RESULTS: Of the total sample (N = 948), 105 (11.1%) were vaccinated at least once at T2. The crude mean scores of psychological distress at T1 and T2 were 41.8 and 42.0 for vaccinated participants and 41.2 and 41.2 for nonvaccinated participants, respectively, with no significant effect of having been vaccinated (Cohen's d = 0.02, P = 0.833). After adjusting the covariates, there was no significance (P = 0.446). CONCLUSIONS: The COVID-19 vaccination was supposed to have a limited effect on mental health among Japanese employees in an early phase of vaccination. To keep providing mental health care for employees is important even after starting the vaccination program.

The Effect of the Imacoco Care Psychoeducation Website on Improving Psychological Distress Among Workers During the COVID-19 Pandemic: Randomized Controlled Trial.

BACKGROUND: The prolonged COVID-19 pandemic has affected mental health among workers. Psychoeducational intervention via a website could be effective for primary prevention of mental illness among workers in the current COVID-19 pandemic. OBJECTIVE: The aim of this randomized controlled trial is to examine the effect of a newly developed online psychoeducational website named Imacoco Care on reducing psychological distress and fear about COVID-19 infection among workers. METHODS: Participants in the study were recruited from registered members of a web survey company in Japan. Participants who fulfilled the eligibility criteria were randomly allocated to the intervention or control group. Participants in the intervention group were invited to access the Imacoco Care program within a month after the baseline survey. The Kessler Psychological Distress Scale (K6) and the Fear of COVID-19 Scale (FCV-19S) scores were obtained at baseline and at 1- and 3-month follow-ups. RESULTS: A total of 1200 workers were randomly allocated to the intervention and control groups (n=600 [50%] per group). The Imacoco Care intervention group showed a significant favorable effect on K6 scores (P=.03) with a small effect size (ES; Cohen d=-0.14) and an adverse effect on FCV-19S scores (P=.01) with a small ES (Cohen d=0.16) at 3-month follow-up. In the per protocol analysis (including only participants who had read the Imacoco Care content at least 1 time), the Imacoco Care intervention group also showed a significant favorable effect on reducing K6 scores (P=.03), while an adverse effect on FCV-19S scores was not significant (P=.06) in the intervention group at 3-month follow-up. CONCLUSIONS: A web-based psychoeducation approach may be effective for improving psychological distress among workers; however, it may be important not only to distribute information but also to encourage active engagement with the content of the program to prevent adverse effects of psychoeducational intervention. TRIAL REGISTRATION: University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR) UMIN000042556; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000048548.

Increased suicidal ideation in the COVID-19 pandemic: an employee cohort in Japan.

OBJECTIVES: This study investigated the change in suicidal ideation and its risk factors among employees. A longitudinal cohort study was conducted, starting with the baseline online survey in March 2020 (T1), followed by May (T2), and August (T3). The change in suicidal ideation from T2 to T3 and relevant factors associated with suicidal ideation at T3 were examined. Suicidal ideation significantly increased between May and August 2020 among females, younger (under 39 years old), highly educated population, and those without pre-existing mental health conditions. Factors significantly associated with suicidal ideation were younger age, suicidal ideation at T2, and with pre-existing mental health conditions. Loneliness at T2 showed a significant association with suicidal ideation, if adjusting those without pre-existing mental health conditions. National and community support is needed to target people who are likely to be left behind, such as young people and those with pre-existing mental health conditions, in the pandemic. METHOD: A longitudinal study was conducted with a cohort of full-time employees, starting with the baseline online survey in March 2020 (time point 1), followed by May (time point 2) and August (time point 3). The change in suicidal ideation from time point 2 to 3, and relevant factors associated with suicidal ideation at time point 3, were examined. RESULTS: Suicidal ideation significantly increased between time points 2 and 3 among women, younger people (aged <39 years), those who were highly educated and those without pre-existing mental health conditions. Factors significantly associated with suicidal ideation were younger age, suicidal ideation at time point 2 and pre-existing mental health conditions. Loneliness at time point 2 showed a significant association with suicidal ideation when adjusting for those without pre-existing mental health conditions. CONCLUSIONS: National and community support is needed to target people who are likely to be left behind, such as young people, those with pre-existing mental health conditions and those experiencing loneliness, in the COVID-19 pandemic.

Effectiveness of an Internet-Based Machine-Guided Stress Management Program Based on Cognitive Behavioral Therapy for Improving Depression Among Workers: Protocol for a Randomized Controlled Trial.

BACKGROUND: The effect of an unguided internet-based cognitive behavioral therapy (iCBT) stress management program on depression may be enhanced by applying artificial intelligence (AI) technologies to guide participants adopting the program. OBJECTIVE: The aim of this study is to describe a research protocol to investigate the effect of a newly developed iCBT stress management program adopting AI technologies on improving depression among healthy workers during the COVID-19 pandemic. METHODS: This study is a two-arm, parallel, randomized controlled trial. Participants (N=1400) will be recruited, and those who meet the inclusion criteria will be randomly allocated to the intervention or control (treatment as usual) group. A 6-week, six-module, internet-based stress management program, SMART-CBT, has been developed that includes machine-guided exercises to help participants acquire CBT skills, and it applies machine learning and deep learning technologies. The intervention group will participate in the program for 10 weeks. The primary outcome, depression, will be measured using the Beck Depression Inventory II at baseline and 3- and 6-month follow-ups. A mixed model repeated measures analysis will be used to test the intervention effect (group × time interactions) in the total sample (universal prevention) on an intention-to-treat basis. RESULTS: The study was at the stage of recruitment of participants at the time of submission. The data analysis related to the primary outcome will start in January 2022, and the results might be published in 2022 or 2023. CONCLUSIONS: This is the first study to investigate the effectiveness of a fully automated machine-guided iCBT program for improving subthreshold depression among workers using a randomized controlled trial design. The study will explore the potential of a machine-guided stress management program that can be disseminated online to a large number of workers with minimal cost in the post-COVID-19 era. TRIAL REGISTRATION: UMIN Clinical Trials Registry（UMIN-CTR) UMIN000043897; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000050125. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/30305.

Changes in COVID-19 measures in the workplace: 8-month follow-up in a cohort study of full-time employees in Japan.

OBJECTIVES: It is unclear how many workplace COVID-19 preventive measures were maintained during repeated outbreaks. The aim of this study was to investigate a longitudinal change of implementation of workplace preventive measures responding to COVID-19 in Japan. METHODS: An online longitudinal study was conducted using a cohort of full-time employees in Japan, starting in March 2020 (T1), with follow-up surveys in May (T2), August (T3), and November (T4) 2020. A repeated measures analysis of variance was performed to compare the difference among the four surveys in the mean number of 23 predetermined items of the measures implemented. RESULTS: The final sample comprised 800 employees. The mean number of the implemented measures increased from T1 to T2, but did not change from T2 to T3, then decreased from T3 to T4. The number of workplace preventive measures significantly increased from T1 to T2 for 21 items (P < .001), and significantly decreased from T3 to T4 for 14 items (P < .001 to P = .005). CONCLUSIONS: While the preventive measures responding to COVID-19 in the workplace were well-implemented during the earlier phase of the outbreak, they seem to have been relaxed after a huge outbreak (T3 to T4: August to November 2020). Workplaces should be encouraged to continue the preventive measures over repeated outbreaks.

Sustained poor mental health among healthcare workers in COVID-19 pandemic: A longitudinal analysis of the four-wave panel survey over 8 months in Japan.

OBJECTIVES: This study aimed to compare the longitudinal change of the psychological distress of healthcare workers (HCWs) with non-HCWs during the repeated outbreaks of the COVID-19 in Japan. METHODS: The data were retrieved from the Employee Cohort Study in the Covid-19 pandemic in Japan study. An online survey was conducted on March 2020 (T1), on May 2020 (T2), on August 2020 (T3), and on November 2020 (T4). Psychological distress was measured by the Brief Job Stress Questionnaire. A mixed-model repeated-measures ANOVA was conducted as an indicator of the group differences. RESULTS: A total sample of analysis was n = 996 (HCWs, n = 111; non-HCWs, n = 885). HCWs consisted of physicians/nurses/midwives and other HCWs (eg, pharmacists, clinical laboratory technicians) in the clinical settings (n = 19; 17% and n = 61; 55%, respectively), and HCWs not working in the clinical settings (n = 31; 28%). Being HCWs were associated with a significant increase in psychological distress from T1 to T2, T3 and T4 (P = .001, P = .002, P < .001; respectively). CONCLUSIONS: The mental health of HCWs deteriorated through the COVID-19 outbreaks compared with non-HCWs. HCWs are continuously the important targets to provide mental health support.

The Effects of Downloading a Government-Issued COVID-19 Contact Tracing App on Psychological Distress During the Pandemic Among Employed Adults: Prospective Study.

BACKGROUND: Downloading a COVID-19 contact tracing app may be effective in reducing users' worry about COVID-19 and psychological distress. OBJECTIVE: This 2.5-month prospective study aimed to investigate the association of downloading a COVID-19 contact tracing app, the COVID-19 Contact Confirming Application (COCOA), released by the Japanese government, with worry about COVID-19 and psychological distress in a sample of employed adults in Japan. METHODS: A total of 996 full-time employed respondents to an online survey conducted May 22-26, 2020 (baseline), were invited to participate in a follow-up survey August 7-12, 2020 (follow-up). A high level of worrying about COVID-19 and high psychological distress were defined by baseline and follow-up scores on a single-item scale and the Kessler 6 (K6) scale, respectively. The app was released between the two surveys, on June 17. Participants were asked at follow-up if they downloaded the app. RESULTS: A total of 902 (90.6%) of 996 baseline participants responded to the follow-up survey. Among them, 184 (20.4%) reported that they downloaded the app. Downloading of the contact tracing app was significantly negatively associated with psychological distress at follow-up after controlling for baseline variables, but not with worry about COVID-19. CONCLUSIONS: This study provides the first evidence that using a government-issued COVID-19 contact tracing app may be beneficial for the mental health of employed adults during the COVID-19 pandemic.