Factors Associated with Serious Psychological Distress during the COVID-19 Pandemic in Japan (preprint)

Importance: The coronavirus disease 2019 (COVID-19) pandemic may have a negative impact on mental health, leading to higher suicide rates in many countries. However, little is known about the factors associated with worsened mental health during the COVID-19 pandemic. Objective: To investigate the factors associated with serious psychological distress (SPD) during the COVID-19 pandemic in Japan. Design, Setting, and Participants: A cross-sectional study using a large-scale internet survey conducted between August 25 and September 30, 2020, in Japan. Exposures: Demographics (age, gender, marital status, family composition, and caregiving burden), socio-economic status (income level, employment type, educational attainment); the experience of domestic violence (DV), the state of emergency, fear of COVID-19, and stigma related to COVID-19. Main Outcomes and Measures: Prevalence of SPD, defined as Kessler 6 scale score [≥]13. Results: Among 25,482 individuals included in this study, 2,556 (10%) met the criteria of SPD. Overall, women (adjusted odds ratio [aOR] 1.59; 95%CI, 1.17-2.16; P=0.003), ages 15-29 (aOR compared with ages 45-59, 2.35; 95%CI, 1.64-3.38; P<0.001), low income (aOR compared with intermediate income, 1.70; 95%CI, 1.16-2.49; P=0.007), those who provide caregiving to family members (aOR, 5.48; 95%CI, 3.51-8.56; P<0.001), experiencing DV (aOR, 5.72; 95%CI, 3.81-8.59; P<0.001), and fear of COVID-19 (aOR, 1.96; 95%CI, 1.55-2.48; P<0.001) were associated with a higher prevalence of SPD. Among women aged 15-29 years who experienced the highest rate of SPD, caregiving, DV, fear of COVID-19, and COVID-19-related stigma were associated with a higher likelihood of SPD; whereas economic situation (income level and employment type) and social isolation (marital status) were not associated with the prevalence of SPD. Conclusions and Relevance: Economic situation, caregiving burden, DV, and fear of COVID-19 were independently associated with SPD during the COVID-19 pandemic. Among young women--who have a higher risk of suicide during the COVID-19 pandemic in Japan--similar factors, except economic situation, were associated with a higher rate of 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.

Association between Participation in Government Subsidy Program for Domestic Travel and Symptoms Indicative of COVID-19 Infection (preprint)

ImportanceAs countermeasures against the economic downturn caused by the coronavirus 2019 (COVID-19) pandemic, many countries have introduced or considering financial incentives for people to engage in economic activities such as travel and use restaurants. Japan has implemented a large-scale, nationwide government-funded program that subsidizes up to 50% of all travel expenses since July 2020 with the aim of reviving the travel industry. However, it remains unknown as to how such provision of government subsidies for travel impacted the COVID-19 pandemic. ObjectiveTo investigate the association between participation in government subsidies for domestic travel in Japan and the incidence of COVID-19 infections. Design, Setting, and ParticipantsUsing the data from a large internet survey conducted between August 25 and September 30, 2020, in Japan, we examined whether individuals who used subsidies experienced a higher likelihood of symptoms indicative of the COVID-19 infection. ExposureParticipation in the government subsidy program for domestic travel. Main Outcomes and MeasuresFive symptoms indicative of the COVID-19 infection (high fever, sore throat, cough, headache, and smell and taste disorder) within the past one month of the survey. ResultsOf the 25,482 respondents (50.3% [12,809] women; mean [SD] age, 48.4 [17.4] years), 3,289 (12.9%) participated in the subsidy program at the time of survey. After adjusting for potential confounders, we found that participants in the subsidy program exhibited higher incidence of high fever (adjusted rate, 4.8% for participants vs. 3.7% for non-participants; adjusted odds ratio [aOR], 1.90; 95%CI, 1.42-2.54; p<0.001), sore throat (19.8% vs. 11.3%; aOR, 2.09; 95%CI, 1.37-3.20; p=0.002), cough (19.1% vs. 11.2%; aOR 1.96; 95%CI, 1.27-3.02; p=0.007), headache (29.1% vs. 25.5%; aOR, 1.24; 95%CI, 1.07-1.43; p=0.007), and smell and taste disorder (2.6% vs. 1.8%; aOR 1.98; 95%CI; 1.15-3.40; p=0.01) compared with non-participants. Conclusion and RelevanceThe participants of government subsidies for domestic travel experienced a higher incidence of symptoms indicative of the COVID-19 infection.