[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.

Risk factors for workplace bullying, severe psychological distress and suicidal ideation during the COVID-19 pandemic among the general working population in Japan: a large-scale cross-sectional study.

OBJECTIVES: To investigate the risk factors for workplace bullying and mental health outcomes among workers during the COVID-19 pandemic. DESIGN: A cross-sectional study. SETTING: A nationwide online survey was conducted from August to September 2020 in Japan. PARTICIPANTS: 16 384 workers (men: n=9565; women: n=6789). MAIN OUTCOME VARIABLES: Workplace bullying was measured by one item from the Brief Job Stress Questionnaire; severe psychological distress according to the Kessler Psychological Distress Scale (≥13) and suicidal ideation by one item. Prevalence ratios were calculated by modified Poisson regression analyses adjusting for potential confounders such as gender, age, occupational characteristics and a prior history of depression. RESULTS: Overall, 15% of workers experienced workplace bullying, 9% had severe psychological distress and 12% had suicidal ideation during the second and third wave of the COVID-19 pandemic in Japan. The results of this study showed men, executives, managers and permanent employees had a higher risk of bullying than women or part-time workers. Increased physical and psychological demands were common risk factors for bullying, severe psychological distress and suicidal ideation. Starting to work from home was a significant predictor for adverse mental health outcomes but a preventive factor against workplace bullying. CONCLUSIONS: The results of this study showed different high-risk groups for bullying or mental health during the pandemic. Any intervention to decrease workplace bullying or mental health problems should focus not only on previously reported vulnerable workers but also workers who have experienced a change in work style or job demands.

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 stigma and its relationship with mental wellbeing: A cross-sectional analysis of a cohort study in Japan

Objective Social stigma related to coronavirus disease (COVID-19), i. e., COVID-19 stigma, forms a burden on people socially, economically, and mentally. This study assessed COVID-19 stigma using a scale to identify a population likely to exhibit higher prejudice against COVID-19 itself as well as those infected with COVID-19. Methods We adapted and modified the Cancer Stigma Scale to assess COVID-19 stigma and used it as the baseline survey of a cohort study in Japan. The questionnaire was disseminated to 1,573 participants (51.7% men) between December 2020 and March 2021. The questionnaire items included the infection status of individuals close to the respondent and their preventive behaviors related to COVID-19, quality of life (QOL;using the EuroQoL 5-Dimension 5-Level [EQ-5D-5L]), and psychological distress (using the 6-item Kessler Psychological Distress Scale [K6]). Exploratory and confirmatory factor analyses were performed to validate the COVID-19 stigma scale, and we further used the structural equation modeling (SEM) to assess the relationship with QOL and psychological distress. Results COVID-19 stigma was calculated for the 257 (16.3%) participants who responded to the questionnaire. The mean age (standard deviation) was 54.5 (14.4) years, and 50.2% were men. Factor analysis revealed a five-factor model: Awkwardness (feeling uncomfortable being with a person infected before), Severity (fear of not being able to return to normal after infection), Avoidance (attitude of avoiding infected persons), Policy Opposition (expecting more public funding investment), and Personal Responsibility (believing that infected persons themselves are responsible for their infection). Participants > 70 years had the highest scores among other age groups considering all factors except for Policy Opposition. Standardized coefficients in SEM for COVID-19 stigma (latent variable) was highest for Severity (beta = 0.86). Regression coefficients of COVID-19 stigma on K6 and QOL were 0.21 (95% confidence interval [CI] 0.074–0.342) and −0.159 (95% CI −0.295–0.022), respectively. Conclusion People aged ≥ 70 years are more likely to exhibit COVID-19 stigma. Additionally, the results indicate that COVID-19 stigma impacts QOL and psychological distress.

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.

The effect of social restrictions, loss of social support, and loss of maternal autonomy on postpartum depression in 1 to 12-months postpartum women during the COVID-19 pandemic.

BACKGROUND: This study focused on postpartum women, who are one of the most vulnerable populations during the COVID-19 pandemic, aiming to reveal mental health consequences of social restrictions, loss of social support, and loss of autonomy. METHODS: We conducted a cross-sectional study for postpartum women in October 2020 in Japan (N = 600). The Edinburgh Postpartum Depression Scale (EPDS) was used to measure postpartum depression. The prevalence ratios were estimated by log-binomial regression models, adjusting for age, education, household income, residential area, parity, the timing of delivery, and a prior history of depression. RESULTS: The prevalence of postpartum depression was 28.7% (EPDS ≥9, which is frequently used in Japan), 18.6% (≥11), and 13.1% (≥13). Social restrictions, including cancellation of home visits by healthcare professionals and cancellation of infant checkups or vaccinations, loss of support during pregnancy or after delivery, including loss of opportunities to consult with healthcare professionals or friends and cancellation of parents or other family members' visits to support, and loss of autonomy about delivery or breastfeeding, were associated with postnatal depression. CONCLUSIONS: At least 13% of women who delivered and raised babies during the COVID-19 pandemic had postpartum depressive symptoms. COVID-19 related social restrictions and loss of social support from healthcare professionals, families, and friends were significantly associated with postpartum depression. In addition, loss of maternal autonomy in delivery and breastfeeding was associated with postpartum depression. The results indicate that both formal and informal support should not be limited to preventing postpartum depression during a pandemic.

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.

Did Children in Single-Parent Households Have a Higher Probability of Emotional Instability during the COVID-19 Pandemic? A Nationwide Cross-Sectional Study in Japan.

The influence of public health measures against COVID-19 in Japan on child mental health by household type is unknown. This study aimed to investigate whether COVID-19 and the declaration of a state of emergency in Japan affected children's mental health between single-parent and two-parent households disproportionately. A large cross-sectional online survey was conducted from August to September 2020. The study included 3365 parents with children aged 0-14 years old who reported their children's mental status during the declared state of emergency. Emotional instability was reported dichotomously by parents. As the primary result, the probability of emotional instability was higher in single-parent households compared with that in two-parent households after adjustments for potential covariates; the adjusted prevalence ratio (95% CI) was 1.26 (1.07-1.49). Our findings suggest a disproportionate impact on children's mental health due to the pandemic.

Disrupted care during the COVID-19 state of emergency and productivity loss attributed to presenteeism in workers: a nationwide cross-sectional study.

OBJECTIVES: The COVID-19 pandemic has caused medical care delays and avoidance around the globe. However, little is known about the relationship between disrupted care and productivity loss attributed to presenteeism during the COVID-19 pandemic. We aimed to investigate whether disrupted care during the COVID-19 state of emergency was associated with health status and productivity loss. METHODS: We used data from a nationwide, cross-sectional, Internet-based, self-administered survey. We performed multiple logistic regression analysis on data from 14 545 participants to investigate the associations among variables related to disrupted care, health status and the Work Functioning Impairment Scale, with a cut-off of 21 points. RESULTS: Participants who experienced exacerbation of underlying disease (adjusted OR (aOR) 2.84; 95% CI 2.28 to 3.53) or any type of disrupted care were more likely to show low productivity at work. Experiencing disruptions in routine and non-routine clinical settings (aOR 4.64; 95% CI 3.64 to 5.92 and aOR 6.29; 95% CI 4.74 to 8.34, respectively), and running out of drugs (aOR 6.13; 95% CI 4.60 to 8.18) were strongly associated with exacerbation of underlying disease. CONCLUSIONS: Workers who experienced disrupted care were much more likely to show productivity loss. Exacerbation of underlying disease is one possible pathway through which disrupted care could affect productivity loss attributed to presenteeism. Our study provides evidence of the importance of early diagnosis and continuous treatment of non-COVID-19 patients to enable them to remain healthy and continue to work during the pandemic.

Workplace Bullying and Patient Aggression Related to COVID-19 and its Association with Psychological Distress among Health Care Professionals during the COVID-19 Pandemic in Japan.

The novel coronavirus disease (COVID-19) pandemic has spread throughout the world. Poor mental health has been reported among healthcare professionals responding to COVID-19. However, no study has examined the impact of COVID-19-related workplace bullying or patient aggression on the mental health of healthcare professionals during the COVID-19 outbreak. This study examined the prevalence of COVID-19-related workplace bullying and patient aggression and its association with psychological distress among healthcare professionals during the COVID-19 outbreak in Japan. This was a cross-sectional study conducted from May 22 to 26, 2020, inviting participants (n = 1,421) from an online survey of full-time employees. We limited the sample to healthcare professionals for further analyses. Using an online self-report questionnaire, workplace bullying and patient aggression related to COVID-19 was measured using nine items with dichotomous response options. Psychological distress was measured using the Japanese version of Brief Job Stress Questionnaire. Among 1,032 participants (72.6%) who completed the survey, 111 healthcare professionals were identified. Among them, 19 participants (17.1%) had experienced any COVID-19-related workplace bullying or patient aggression: 11 participants (9.9%) had experienced any workplace bullying and 12 participants (10.8%) had experienced any patient aggression. Multiple linear regression analysis showed that any bullying or patient aggression related to COVID-19 significantly correlated with psychological distress. It was suggested that a non-negligible proportion of participants experienced workplace bullying or patient aggression related to COVID-19. Preventing and reducing workplace bullying and patient aggression may be effective in improving mental health of healthcare professionals during the COVID-19 outbreak.

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.

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.

Trust and well-being of postpartum women during the COVID-19 crisis: Depression and fear of COVID-19.

During crisis, trust has been found to have a buffering effect in the prevention of the deterioration of mental well-being, as trust is considered to reflect the individual's capability to gain social resources including both formal and informal support. Additionally, during the COVID-19 pandemic, political trust has been found to reduce anxiety. Taking these findings into account, this study explores the association of generalised and political trust with mental well-being on current postpartum women who were particularly at risk due to a decline in social support leaving them an increased burden of caring newborns during the pandemic. We conducted a crosssectional survey in October 2020 in Japan (n=558). Depressive symptoms (above the cutoff of the Edinburgh Postnatal Depression Scale (EPDS)) and Fear of Coronavirus-19 Scale (FCV-19S) scores were used as mental well-being indicators. Generalised and political trust were captured by binary variables. Results of regression analyses, in which covariates were fully adjusted, showed that higher generalised trust had a statistically significant association with lower possibility of depressive symptoms and a lower FCV-19S score, while political trust was not significantly associated with either indicator. For further understanding, we divided respondents into two groups; women living in cities where higher COVID-19 cases were reported and women living in areas with lower COVID-19 cases, to test whether the role of trust differs depending on the infection spread status. It was found that a higher generalised trust was significantly associated with a lower probability of having depressive symptoms in the areas with lower COVID-19 cases. However, statistical significance was not observed in the areas with high COVID-19 cases. This highlighted that even postpartum women who were normally capable of receiving formal and informal social support need to be taken care of in the current situation.

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.

Urbanization level and neighborhood deprivation, not COVID-19 case numbers by residence area, are associated with severe psychological distress and new-onset suicidal ideation during the COVID-19 pandemic.

BACKGROUND: Recent studies indicate an urgent need to take action against mental health issues during the COVID-19 pandemic. However, the association between larger-scale environmental factors such as living conditions and mental health problems during the pandemic is currently unknown. METHODS: A nationwide, cross-sectional internet survey was conducted in Japan between August and September 2020 to examine the association between urbanization level and neighborhood deprivation as living conditions and COVID-19 case numbers by prefecture. Prevalence ratios (PRs) for severe psychological distress, suicidal ideation, and new-onset suicidal ideation during the pandemic were adjusted for potential confounders. RESULTS: Among 24,819 responses analyzed, the prevalence of mental health problems was 9.2% for severe psychological distress and 3.6% for new-onset suicidal ideation. PRs for severe psychological distress were significantly associated with higher urbanization level (highest PR = 1.30, 95% CI = 1.08-1.56). PRs for new-onset suicidal ideation were significantly associated with higher urbanization level (highest PR = 1.83, 95% CI = 1.37-2.45) and greater neighborhood deprivation (highest PR = 1.35, 95% CI = 1.06-1.72). Severe psychological distress and new-onset suicidal ideation were significantly more prevalent when there was higher urbanization plus lower neighborhood deprivation (PR = 1.34 [1.15-1.56], and 1.57 [1.22-2.03], respectively). CONCLUSION: These findings suggest that it is not the number of COVID-19 cases by residence area but higher urbanization level and greater neighborhood deprivation (lower neighborhood-level socioeconomic status) that are associated with severe psychological distress and new-onset suicidal ideation during the pandemic. These findings differ in part from evidence obtained before the pandemic.

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.