Correction: Emotional Distress During COVID-19 by Mental Health Conditions and Economic Vulnerability: Retrospective Analysis of Survey-Linked Twitter Data With a Semisupervised Machine Learning Algorithm.

[This corrects the article DOI: 10.2196/44965.].

Emotional Distress During COVID-19 by Mental Health Conditions and Economic Vulnerability: Retrospective Analysis of Survey-Linked Twitter Data With a Semisupervised Machine Learning Algorithm.

BACKGROUND: Monitoring the psychological conditions of social media users during rapidly developing public health crises, such as the COVID-19 pandemic, using their posts on social media has rapidly gained popularity as a relatively easy and cost-effective method. However, the characteristics of individuals who created these posts are largely unknown, making it difficult to identify groups of individuals most affected by such crises. In addition, large annotated data sets for mental health conditions are not easily available, and thus, supervised machine learning algorithms can be infeasible or too costly. OBJECTIVE: This study proposes a machine learning framework for the real-time surveillance of mental health conditions that does not require extensive training data. Using survey-linked tweets, we tracked the level of emotional distress during the COVID-19 pandemic by the attributes and psychological conditions of social media users in Japan. METHODS: We conducted online surveys of adults residing in Japan in May 2022 and collected their basic demographic information, socioeconomic status, and mental health conditions, along with their Twitter handles (N=2432). We computed emotional distress scores for all the tweets posted by the study participants between January 1, 2019, and May 30, 2022 (N=2,493,682) using a semisupervised algorithm called latent semantic scaling (LSS), with higher values indicating higher levels of emotional distress. After excluding users by age and other criteria, we examined 495,021 (19.85%) tweets generated by 560 (23.03%) individuals (age 18-49 years) in 2019 and 2020. We estimated fixed-effect regression models to examine their emotional distress levels in 2020 relative to the corresponding weeks in 2019 by the mental health conditions and characteristics of social media users. RESULTS: The estimated level of emotional distress of our study participants increased in the week when school closure started (March 2020), and it peaked at the beginning of the state of emergency (estimated coefficient=0.219, 95% CI 0.162-0.276) in early April 2020. Their level of emotional distress was unrelated to the number of COVID-19 cases. We found that the government-induced restrictions disproportionately affected the psychological conditions of vulnerable individuals, including those with low income, precarious employment, depressive symptoms, and suicidal ideation. CONCLUSIONS: This study establishes a framework to implement near-real-time monitoring of the emotional distress level of social media users, highlighting a great potential to continuously monitor their well-being using survey-linked social media posts as a complement to administrative and large-scale survey data. Given its flexibility and adaptability, the proposed framework is easily extendable for other purposes, such as detecting suicidality among social media users, and can be used on streaming data for continuous measurement of the conditions and sentiment of any group of interest.

Hilar lymphadenopathy, development of tubulointerstitial nephritis, and dense deposit disease following Pfizer-BioNTech COVID-19 vaccination.

Despite the reports on glomerulonephritis associated with COVID-19 mRNA vaccines, no study has reported about the dense deposit disease (DDD). Here, we present a case of hilar lymphadenopathy after the COVID-19 mRNA vaccination, following which the patient developed tubulointerstitial nephritis (TIN) and DDD. A 74-year-old man received his second dose of mRNA vaccine, and on the next day, he developed fever, urticaria, and dyspnea. On further examination, he had pleural effusion and right hilar lymphadenopathies, which were improved with conservative therapy. After 48 days of the second vaccination, he developed renal dysfunction and new-onset hematuria. Light microscopy findings by renal biopsy revealed apparent mesangial cell proliferation, increased mesangial matrix in the glomeruli, and diffuse inflammatory cell infiltration in the interstitium. Immunofluorescence analysis revealed 1 + positive results for IgG and IgM, negative results for IgA, and 2 + positive results for C3 with a garland pattern on the capillary walls. Electron microscopy revealed that severe cell proliferation in the capillary rumen, and continuous, thickened, and highly dark-stained spotty dense deposits in the glomerular basement membrane; and noncontinuous spotty dense deposits in the tubular basement membrane. Based on the decrease in C3 and pathological findings, TIN accompanied with DDD was diagnosed. The mRNA vaccine might have contributed to the development of lymphadenopathies, TIN, and DDD in this case. Moreover, TIN and DDD might be associated with the activated alternative pathway induced by the mRNA vaccine.

Short-term effects of roxadustat on serum copper and iron changes in a peritoneal dialysis patient.

Dysregulation in total body copper causes severe complications and excess copper can be toxic. Divalent metal transporter 1, duodenal cytochrome B, and copper transporter ATPase7A are included in the many intestinal genes transactivated by HlF-α. On July X, 2022 an 80-year-old female patient on peritoneal dialysis was prescribed roxadustat 100 mg, because darbepoetin was unable to increase hemoglobin level effectively. On the same day, icodextrin 1 L was initiated to mitigate edema. Laboratory data showed hemoglobin 9.1 g/dL, transferrin saturation 77%, copper 123 µg/dL, and iron 170 µg/dL before changing to roxadustat. The patient visited us 6 days after the change because of the appetite loss. Transferrin saturation and serum copper and iron levels increased to 90%, 170 and 203 µg/dL, respectively, which were decreased or normalized after discontinuing roxadustat and icodextrin, suggesting that even short-term roxadustat administration can influence copper levels as well as iron levels. Excess copper and iron levels during roxadustat treatment do not immediately equate with toxicity, but indicate a physiological compensation or transient imbalance of metabolism especially in patients treated with ferric citrate. Further investigation for the hypoxia-inducible factor-prolyl hydroxylase inhibitors effects on iron and copper metabolisms is needed. Determining the short-term effect of roxadustat on serum copper and iron in only this case is impossible. Therefore, further accumulation of similar cases is necessary to clarify the short-term effects of roxadustat on serum copper and iron.

Perceptions of social rigidity predict loneliness across the Japanese population.

Loneliness is associated with mental and physical health problems and elevated suicide risk, and is increasingly widespread in modern societies. However, identifying the primary factors underlying loneliness remains a major public health challenge. Historically, loneliness was thought to result from a lack of high-quality social connections, but broader cultural factors (e.g. social norms) are increasingly recognized to also influence loneliness. Here, we used a large-scale survey (N = 4977) to assess to what degree the loneliness epidemic in Japan is associated with traditional measures of social isolation (number of close friends), cultural factors (perceptions of social rigidity, as measured by relational mobility), and socioeconomic factors (e.g. income). We confirmed that a lack of close friends is a dominant factor underlying loneliness in Japan. We also found that perceptions of the social rigidity in one's environment was a major correlate of loneliness. Subjects who perceived lower levels of rigidity in their social environments felt significantly less lonely than those who perceived higher levels of social rigidity, though the association was weak in low income males. Thus, Japanese society and other high social rigidity cultures may need to reflect on the possibility that inflexible traditional norms of socialization are exacerbating loneliness.

High insertion of the right diaphragm complicated with congenital diaphragmatic hernia: A case report of rare thoracoscopic findings.

We encountered a case of high insertion of the right diaphragm complicated with congenital diaphragmatic hernia that was diagnosed based on thoracoscopic findings. A full-term male baby was suspected of having right congenital diaphragmatic hernia or diaphragmatic eventration on postnatal imaging. He only had episodes of mild but prolonged symptoms following upper respiratory tract infection and his course was otherwise uneventful during outpatient monitoring. At 1 year old, the elevated liver volume remained large, which might eventually interfere with his lung growth, so thoracoscopic exploration was planned. Thoracoscopy revealed liver prolapse from a diaphragmatic defect. In addition, the anterior to lateral inserted part of the diaphragm was high, with the anterior part reaching the fourth rib. We repaired only the diaphragmatic defect without repositioning the diaphragm, and the postoperative course was uneventful. High insertion of the diaphragm should be considered as a differential diagnosis of congenital diaphragmatic eventration.

Economic crisis and mental health during the COVID-19 pandemic in Japan.

BACKGROUND: The economic crisis induced by the COVID-19 pandemic can have a serious impact on population mental health. This study seeks to understand whether the economic shocks associated with the pandemic have a differential impact by sex because the current pandemic may have disproportionally affected women compared to men. METHODS: We analyzed data from original online monthly surveys of the general population in Japan conducted between April 2020 and February 2021 (N = 9000). We investigated whether individuals who had experienced a major job-related adverse change were more likely to have experienced depressive symptoms (PHQ-9) and anxiety disorders (GAD-7) during the pandemic and also if its effect varied by sex. RESULTS: The results of logistic regression suggest that depressive and anxiety symptoms were more prevalent among those who had recently experienced drastic changes in employment and working conditions, as well as among individuals with low income and those without college education. We also found that both female and male respondents who had experienced a major employment-related change exhibited depression and anxiety disorders. LIMITATIONS: We do not have data on the pre-COVID mental health conditions of our respondents, and our findings are descriptive. Some segments of the population may not be represented in our sample because our surveys were conducted online. CONCLUSIONS: COVID-induced economic shocks can have a detrimental effect on mental health among both economically vulnerable female and male workers.

Resection of Pulmonary Metastases 12 Years after Initial Surgery for a Benign Pheochromocytoma.

We describe a rare case of newly discovered pulmonary metastases and surgical confirmation 12 years after initial surgery for a pheochromocytoma. A 61-year-old asymptomatic man was referred because of an abnormal shadow in the right lung field upon chest radiography. Computed tomography (CT) showed two well-demarcated tumors in the basal segment of the right lung. Twelve years previously, he underwent right adrenalectomy and was pathologically diagnosed as having a benign pheochromocytoma. Thereafter, he received a medical check-up annually. To confirm the diagnosis of two pulmonary tumors, video-assisted thoracic surgery was done and wedge resection of the right lower lobe completed. Pathology studies revealed these tumors as pulmonary metastases from the pheochromocytoma, which indicated that the true diagnosis was a malignant pheochromocytoma. Patients with a benign pheochromocytoma should continue to undergo careful monitoring for a long time after the initial surgical procedure. Thoracic surgeons should be aware of the possibility of pulmonary metastases even if >10 years have passed since initial resection of a benign pheochromocytoma.

Suicide Risk and Prevention During the COVID-19 Pandemic: One Year On.

Emerging data from high and upper-middle-income countries indicate that suicide rates generally did not increase during the initial months of the COVID-19 pandemic, yet the pandemic's impact on suicide is complex. We discuss the nuances of this relationship, how it may evolve over time, and describe the specific steps that governments and societies must take to mitigate harm and prevent suicides in the late stages and aftermath of the pandemic.

Short-Term Effect of the COVID-19 Pandemic on Suicidal Ideation.

Background: Few studies have examined the effect of pandemics on suicide-related outcomes. Aims: We examined whether suicidal ideation levels among the general population changed owing to the COVID-19 pandemic by tracking individuals between January and April 2020. Method: We used a prospective observational longitudinal design (n = 6,683) and stratified sampling to conduct online surveys of the general adult population in Japan before (baseline) and during the pandemic (follow-up). Results: Suicidal ideation levels were significantly lower during than before the pandemic; however, the effect size was very small. Participants who were younger, with unstable employment, without children, with low income, and receiving psychiatric care were more likely to have higher suicidal ideation levels during the pandemic. Limitations: Because this was an Internet survey and subject to selection bias, the sample was not necessarily representative of the Japanese population. At the time of the survey, COVID-19 cases and deaths in Japan were relatively lower than in other developed countries. The dropout rate may have affected the results. Conclusion: Although the short-term impact of the COVID-19 pandemic on suicidal ideation is limited, relatively young and economically vulnerable individuals are more likely to show exacerbated suicidal ideation during the pandemic.

Suicide and mental health during the COVID-19 pandemic in Japan.

BACKGROUND: The coronavirus disease (COVID-19) pandemic is an unprecedented public health crisis, but its effect on suicide deaths is little understood. METHODS: We analyzed data from monthly suicide statistics between January 2017 and October 2020 and from online surveys on mental health filled out by the general population in Japan. RESULTS: Compared to the 2017-19 period, the number of suicide deaths during the initial phase of the pandemic was lower than average but exceeded the past trend from July 2020. Female suicides, whose numbers increased by approximately 70% in October 2020 (incidence rate ratio: 1.695, 95% confidence interval: 1.558-1.843), were the main source of this increase. The largest increase was found among young women (less than 40 years of age). Our survey data indicated that the status of young women's mental health has been deteriorating in recent months and that young female workers were more likely to have experienced a job or income loss than any other group, suggesting adverse economic conditions surrounding them. CONCLUSIONS: Continuous monitoring of mental health, particularly that of the most vulnerable populations identified in this study, and appropriate suicide prevention efforts are necessary during the COVID-19 pandemic.

Is suicide underreported? Evidence from Japan.

PURPOSE: The underreporting of suicides has been a serious global concern among scholars and policymakers. Several studies have sought to detect the prevalence of underreporting by examining whether suicide mortality rates are negatively correlated with those due to unknown intent or causes. This study adds to the literature by examining the potential underreporting of suicides in Japan, where suicide rates have greatly declined in the recent years. METHODS: We compiled subnational data from 47 prefectures between 1995 and 2016, obtained from Vital Statistics of Japan. We examined whether (1) mortality rates due to unknown intent or causes increased as suicide rates decreased; and (2) major socioeconomic causes of suicide (unemployment and divorce rates) had any relationship with the deaths due to unknown intent or causes. RESULTS: Our analysis indicates that mortality rates due to unknown intent or causes were uncorrelated with suicide rates and the above socioeconomic indicators. CONCLUSIONS: In Japan, the frequency of suicides has no systematic relationship with deaths due to unknown intent or causes, suggesting the accuracy of suicide statistics.

Loneliness in Japan during the COVID-19 pandemic: Prevalence, correlates and association with mental health.

Loneliness, which is increasingly recognised as an important public health problem, may have increased during the COVID-19 pandemic in the wake of social distancing measures. This study examined loneliness in Japan during the ongoing pandemic and its association with mental health. Cross-sectional online survey data that were collected at monthly intervals from April to December 2020 were analysed. Loneliness was assessed with the Three-Item Loneliness Scale. Information was also obtained on depressive (PHQ-9) and anxiety (GAD-7) symptoms. Logistic regression analysis was used to examine associations. For the combined sample (N = 9000), 41.1% of the respondents were categorised as lonely when using ≥ 6 as a cutoff score, and 16.5% when the cutoff was ≥ 7. The prevalence of loneliness changed little across the period. Younger age, male sex and socioeconomic disadvantage (low income, deteriorating financial situation, unemployment) were associated with loneliness. In fully adjusted analyses, loneliness was linked to depressive (odds ratio [OR]: 5.78, 95% confidence interval [CI]: 5.08-6.57) and anxiety symptoms (OR: 5.34, 95% CI: 4.53-6.29). Loneliness is prevalent in Japan during the COVID-19 pandemic and associated with socioeconomic disadvantage and poorer mental health. A focus on loneliness as a public health issue in Japan is now warranted.

Pre-pandemic suicidal ideation and COVID-19 preventive behavior: a prospective cohort study.

We investigated the association between suicidal ideation and COVID-19 preventive behaviors using a prospective observational longitudinal design (N = 6683). The baseline survey was 24 January 2020 (before COVID-19 pandemic, T1) and the follow-up survey was between April 27 and 30, 2020 (during COVID-19 pandemic, T2). The sample was the general adult population in Japan. Adjusted for demographic and socioeconomic factors, high suicidal ideation at T1 was associated with significantly low levels of engagement in COVID-19 preventive behaviors at T2. Individuals with strong suicidal ideation before the pandemic were less likely to engage in COVID-19 preventive behaviors.

[Postoperative Severe Dysphagia Due to Hypophosphatemia in a Patient with Peritoneal Dissemination of Gastric Cancer].

An 83-year-old man presented with melena and weight loss. Upper gastrointestinal endoscopy showed type 3 advanced gastric cancer with pyloric stenosis. Surgical findings revealed numerous peritoneal dissemination, then gastro-jejunum anastomosis was performed. The oral diet was resumed on POD4, however severe dysphagia occurred immediately on POD6. There were no specific findings on MRI/MRA and nasal endoscopy. Serum antibodies related to neuromuscular diseases and connective tissue diseases were also negative. Despite the rehabilitation, the dysphagia remained. Before total parenteral nutrition on POD16, hypophosphatemia was discovered(1.4 mg/dL). His dysphagia disappeared with the improvement in the serum phosphate level. Hypophosphatemia might be caused by an inadequate intake as urine phosphate, serum calcium and serum PTH levels were normal. We present a recent case of severe dysphagia due to hypophosphatemia in a patient with peritoneal dissemination of gastric cancer.

Graph-based open-ended survey on concerns related to COVID-19.

The COVID-19 pandemic is an unprecedented public health crisis with broad social and economic consequences. We conducted four surveys between April and August 2020 using the graph-based open-ended survey (GOS) framework, and investigated the most pressing concerns and issues for the general public in Japan. The GOS framework is a hybrid of the two traditional survey frameworks that allows respondents to post their opinions in a free-format style, which can subsequently serve as one of the choice items for other respondents, just as in a multiple-choice survey. As a result, this framework generates an opinion graph that relates opinions and respondents. We can also construct annotated opinion graphs to achieve a higher resolution. By clustering the annotated opinion graphs, we revealed the characteristic evolution of the response patterns as well as the interconnectedness and multi-faceted nature of opinions. Substantively, our notable finding is that "social pressure," not "infection risk," was one of the major concerns of our respondents. Social pressure refers to criticism and discrimination that they anticipate receiving from others should they contract COVID-19. It is possible that the collectivist nature of Japanese culture coupled with the government's policy of relying on personal responsibility to combat COVID-19 explains some of the above findings, as the latter has led to the emergence of vigilantes. The presence of mutual surveillance can contribute to growing skepticism toward others as well as fear of ostracism, which may have negative consequences at both the societal and individual levels.

Who is more likely to ignore experts' advice related to COVID-19?

Failing to adhere to COVID-19 experts' advice could have devastating consequences for individuals and communities. Here we determine which demographic factors can impact trust in COVID-19 experts. Participants consisted of more than 1875 online volunteers, primarily from the U.S. Survey data were collected before and after the first peak of the COVID-19 outbreak in the U.S. (28th of March-15th of May 2020). We consistently find that participants with a lower perceived socio-economic status, social conservatives, individualists, and participants who are less worried about COVID-19 are significantly more likely to support individuals who ignore the goverment's, scientists', medical professionals' COVID-19 advice. Regarding race, Black participants consistently (and Hispanics to a lesser degree) were more likely to support individuals who ignore the three expert groups relative to Whites. All these findings generalized to weaker trust towards public policy decision experts. Asian and other racial groups' trust was consistently lower than Whites, but primarily numerically, not statistically. Age and gender showed weak or inconsistent results respectively. We provide an enhanced understanding of the demographic factors that can result in individuals/groups ignoring COVID-19 experts. Lack of compliance could increase the transmission risks of the virus. Therefore, non-partisan campaigns that target individuals/groups who distrust COVID-19 experts will likely reduce COVID-19 related deaths. Increasing expert representatives' racial diversity may also increase trust among racial minorities.

Green space and suicide mortality in Japan: An ecological study.

Although numerous studies have investigated the effect of green space on mental health, as yet, little is known about the association between green space and suicide. To address this deficit, we conducted the first Japan-wide study of the relationship between green space and suicide mortality. Results from spatial analyses of municipality-level panel data for the 1975-2014 period that included 886,440 suicide deaths with a fixed-effect estimator showed that green space was associated with suicide mortality, and that this relationship was conditioned by the form of greenness, level of urbanity and demographic characteristics. In densely populated cities, park density (parks per 1000 of the population) was associated with reduced suicide mortality among females aged 18 and above and among males aged 18 to 39 and aged 65 and above. In small- and medium-sized cities, park coverage (% by area) was linked to fewer suicide deaths among middle-aged and older females (aged 40 and above). In contrast, in non-cities (rural areas), parks were not associated with suicide mortality whereas woodland coverage (% by area) was linked to reduced suicide deaths among middle-aged and older males (aged 40 and above). Our findings suggest that urban green space and rural forest coverage may have a protective effect against self-harming behavior. Future suicide prevention efforts should consider an increased greening of the residential environment in terms of both availability and accessibility, especially with better designs that accommodate population needs and local conditions.

Acute stress does not affect economic behavior in the experimental laboratory.

We report statistical results from a laboratory experiment in which participants were required to make decisions with monetary consequences in several solitary and interactive situations under acute stress. Our study follows the tradition of behavioral and experimental economics in selecting the experimental situations and incorporates elements from medical and psychological research in the way stress is induced and measured. It relies on a larger sample, with 192 volunteers, than previous studies to achieve higher statistical power. The main conclusion, drawn from binary comparisons between the treatment and reference groups, is that acute stress does not have a significant impact on cognitive skills, strategic sophistication, risk attitudes, altruism, cooperativeness, or nastiness. Regression analysis, controlling for psycho-social characteristics, corroborates these findings, while also suggesting that acute stress significantly decreases men's risk aversion (as measured by a lottery-choice risk-elicitation task).