How do social networks, perception of social isolation, and loneliness affect depressive symptoms among Japanese adults?

OBJECTIVE: This study aims to elucidate the complex relationship among social isolation, loneliness, and perception of social isolation and its influence on depressive symptoms by evaluating a hypothetical model. This understanding is essential for the formulation of effective intervention strategies. METHODS: We conducted an online survey on Japanese adults (N = 3,315) and used the six-item Lubben Social Network Scale to assess the size of their social networks. We employed a single question to gauge their perception of social isolation. Loneliness was assessed using the three-item UCLA Loneliness Scale, and depressive symptoms were examined using the Patient Health Questionnaire-9. Structural equation modeling was employed to test the hypothesized model. RESULTS: The final model demonstrated satisfactory fit with data (χ2 (1) = 3.73; not significant; RMSEA = 0.03; CFI = 1.00; TLI = 1.00). The size of social network demonstrated a weak negative path to loneliness and depressive symptoms (ß = -.13 to -.04). Notably, a strong positive association existed between perception of social isolation and loneliness (ß = .66) and depressive symptoms (ß = .27). Additionally, a significant positive relationship was found between loneliness and depressive symptoms (ß = .40). Mediation analysis indicated that perception of social isolation and loneliness significantly intensified the relationships between social networks and depressive symptoms. CONCLUSIONS: Results indicate that interventions of psychological approaches, such as cognitive-behavioral therapy, are effective in reducing the perception of social isolation and loneliness, which may lead to the prevention of depressive symptoms. Future longitudinal studies are expected to refine and strengthen the proposed model.

Association of fear of COVID-19 and resilience with psychological distress among health care workers in hospitals responding to COVID-19: analysis of a cross-sectional study.

Background: It remains unclear how fear of COVID-19 and resilience are related to psychological distress based on occupations among healthcare workers (HCWs) in hospitals treating patients with COVID-19. We conducted a survey on the mental health of HCWs during the COVID-19 pandemic to determine the relationship between factors such as fear of COVID-19 and resilience as well as mental distress in each occupation of HCWs. Methods: We conducted a web-based survey among HCWs at seven hospitals treating COVID-19 patients in Japan from December 24, 2020 to March 31, 2021. A total of 634 participants were analyzed, and information regarding their socio-demographic characteristics and employment status was collected. Several psychometric measures were used, including the Kessler's Psychological Distress Scale (K6), the fear of COVID-19 Scale (FCV-19S), and the Resilience Scale (RS14). Factors related to psychological distress were identified by logistic regression analysis. The association between job title and psychological scales was examined by one-way ANOVA, and t-tests were conducted to examine the association between the FCV-19S and hospital initiatives. Results: It was found that nurses and clerical workers were associated with psychological distress without considering FCV-19S or RS14; in a model that included FCV-19S, FCV-19S was associated with psychological distress, but job title was not; when RS14 was considered, resilience was protective. In terms of occupation, FCV-19S was lower among physicians and higher among nurses and clerical workers, while RS14 was higher among physicians and lower among other occupations. Having access to in-hospital consultation regarding infection control as well as to psychological and emotional support was associated with lower FCV-19S. Conclusion: Based on our findings, we can conclude that the level of mental distress differed by occupation and the differences in the fear of COVID-19 and resilience were important factors. In order to provide mental healthcare for HCWs during a pandemic, it is important to create consultation services that enable employees to discuss their concerns. In addition, it is important to take steps to strengthen the resilience of HCWs in preparation for future disasters.

Mental Health of Caregivers Working in Nursing Homes during the COVID-19 Pandemic.

INTRODUCTION: There have been numerous reports of cluster outbreaks of coronavirus disease 2019 (COVID-19) in hospitals and nursing homes. Healthcare workers fighting COVID-19 experience mental health issues. Caregivers in nursing homes experienced increased psychological distress and concern about deterioration of their mental health. We conducted a large-scale web-based survey exploring mental health among caregivers working in nursing homes during the COVID-19 pandemic with the aim of identifying their support needs. METHODS: Survey participants were caregivers working at 284 nursing homes in Ibaraki prefecture, Japan. The survey period was from September 2020 to March 2021. Participants responded to a questionnaire covering gender, age, occupation, infections at facilities, infection protection, changes in nursing home users, cooperation with other medical institutions, and prejudice/discrimination. The Hospital Anxiety and Depression Scale (HADS) was used to evaluate participants' depression and anxiety. RESULTS: In total, 676 participants completed the survey; 350 (52.5%) were with anxiety symptoms and 378 (56.7%) were with depressive symptoms (scores exceeding the HADS cut-off points). The risk for anxiety was associated with being care worker or social worker. The risk of anxiety or depression was high when family caregivers' mental state changed. DISCUSSION/CONCLUSION: This study found that caregivers working in nursing homes were exposed to high levels of stress during the COVID-19 pandemic and were at high risk for developing depression and anxiety.

A longitudinal comparison of college student mental health under the COVID-19 self-restraint policy in Japan.

BACKGROUND: The coronavirus-19 (COVID-19) pandemic has resulted in substantial mental health problems. In addition to the fear of infection, prevention policies that result in isolation such as lockdowns or, in Japan, "self-restraint," are associated with psychological symptoms. University students are vulnerable to emotional disorders because of the psychological challenges associated with the transition to adulthood. Therefore, we investigated changes in the mental health of university students before and during the COVID-19 pandemic. METHODS: We used data from depression screening conducted by the University of Tsukuba, Japan, during student health examinations. Students completed the Patient Health Questionnaire-9 (PHQ-9) and an open-ended question on stress self-coping. RESULTS: In 2020, 9.6% of students were depressed, approximately twice as many as in previous years. The paired samples Wilcoxon test showed that PHQ-9 scores were significantly higher in 2020 than in 2019; the largest effect size was for sleep difficulties. Analysis of the open-ended responses for stress coping strategies showed that physical activity and online communication were most frequently used. LIMITATIONS: The 2020 survey was web-based, whereas the surveys in previous years were completed in person. Only approximately one-sixth of participants answered the open-ended question. CONCLUSIONS: The percentage of students with mental health problems has doubled, and more attention to student mental health is needed. However, many students seem to be using appropriate coping measures. Education about best practices and raising awareness about establishing and maintaining sleep-wake rhythms may be useful.

Crisis-management, Anti-stigma, and Mental Health Literacy Program for University Students (CAMPUS): A preliminary evaluation of suicide prevention.

Background: University students have specific risk factors for suicide, necessitating targeted prevention programs. This preliminary study evaluated the efficacy of the Crisis-management, Anti-stigma, Mental health literacy Program for University Students (CAMPUS) for reduction of risk factors and promotion of preventative behaviors. Methods: A total of 136 medical students attended the CAMPUS as a required course at the national university in Japan. The CAMPUS consisted of a lecture and two group sessions covering mental health literacy, self-stigma, and gatekeeper efficacy (e.g., identifying and helping at-risk individuals). The students were asked to role-play based on a movie about gatekeepers and scripts about self-stigma and suicide-related issues. Participants completed questionnaires on suicidal thoughts, depression, help-seeking intentions, self-efficacy as gatekeepers, self-concealment, and self-acceptance. A total of 121 students completed the questionnaires pre- and post-program, and 107 students also responded six months later. Results: Students demonstrated significantly reduced overall suicide thoughts six months post-program compared to before the program. In addition, gatekeeper self-efficacy, help-seeking intentions for formal resources, and self-acceptance were improved in the students six month after the program. Conclusions: The CAMPUS suggested effective at reducing suicidal people and promoting preventative psychological tendencies among medial students. This study was a one-group pre post design study without control group. The CAMPUS program was delivered as a mandatory requirement to a group with relatively low suicide risk. Further studies are required to assess its suitability for the general university student population.

Proposed Cut-Off Score for the Japanese Version of the Fear of Coronavirus Disease 2019 Scale (FCV-19S): Evidence from a Large-Scale National Survey in Japan.

The Fear of coronavirus disease 2019 (COVID-19) Scale (FCV-19S) is a seven-item self-administered psychological scale for measuring the fear of this disease. The scale has been widely adapted and validated worldwide. This study aimed to propose a cut-off score for the validated Japanese version of the FCV-19S. We conducted a nationwide online survey and included 26,286 respondents in the analysis. Respondents answered questions on their sociodemographic characteristics, and using the FCV-19S and six-item Kessler Psychological Distress Scale, we measured psychological distress and assessed whether the fear of COVID-19 interfered with their daily lives. A total score of ≥21 points was considered adequate to identify those with psychological distress or difficulties in daily living because of the fear of COVID-19. This cut-off score will contribute to mental health assessment during the COVID-19 pandemic.

Association between depressive state and behavioral changes induced by the state of emergency for Coronavirus disease 2019: Evidence from university students in Japan.

Coronavirus disease 2019 (Covid-19) has caused numerous problems worldwide since 2020. The pandemic and subsequent quarantine policies have resulted in numerous psychological problems among students. The quarantine policy forced students to change their behavior and refrain from going out. To date, the relationship between behavioral and psychological changes following the implementation of the quarantine policy has not been investigated. We conducted a web-based survey to investigate the change in time spent out of the house between before and after the implementation of the quarantine policy and how this related to changes in depression. We collected data from 12,088 students, which included the Patients Health Questionnaire-9, frequency of going out, and demographics. We divided subjects into three categories based on the frequency of going out before and after the policy was put in place. Results showed that students who frequently went out before the pandemic and strictly followed the government policy were significantly more depressed than those who did not frequently go out. In contrast, students who had always been reluctant to go out did not have a tendency for depression to worsen. Our findings indicate that behavioral modification leads to depression in those who previously had active social lives.

Demographics Associated With Stress, Severe Mental Distress, and Anxiety Symptoms During the COVID-19 Pandemic in Japan: Nationwide Cross-sectional Web-Based Survey.

BACKGROUND: With the spread of COVID-19, the deterioration of public mental health has become a major global and social problem. OBJECTIVE: The purpose of this study was to elucidate the relationship between the 3 mental health problems associated with COVID-19, that is, perceived stress, severe mental distress, and anxiety symptoms, and the various demographic factors, including occupation. METHODS: A nationwide web-based questionnaire survey was conducted in Japan from August 4 to 31, 2020. In addition to sociodemographic data, the degrees of perceived stress, severe mental distress, and anxiety symptoms associated with COVID-19 were measured. After performing a descriptive statistical analysis, factors related to stress, severe mental distress, and anxiety symptoms were analyzed using logistic regression analysis. RESULTS: A total of 8203 respondents submitted survey responses, among whom 34.9% (2861/8203) felt intense stress associated with COVID-19, 17.1% (1403/8203) were depressed, and 13.5% (1110/8203) had severe anxiety symptoms. The logistic regression analysis showed that each of the 3 mental health problems were prevalent in females, nonbinary gender, people in their 50s, 60s and older, respondents who visited psychiatrists, and those currently in psychiatric care. Severe mental distress and anxiety symptoms were associated with the number of effective lifestyle coping strategies during the lockdown period. Severe mental distress was only prevalent in teenagers and respondents in their 20s, as students tended to develop stress and severe mental distress. With regard to occupation, working in nursing care and welfare, education and research, and medical and health sectors was associated with stress; however, working in these occupations was not associated with severe mental distress and anxiety symptoms. Unemployment was associated with severe mental distress and anxiety symptoms. All 3 mental health problems were prevalent in part-time workers and those working in entertainment and arts sectors. CONCLUSIONS: Gender, age, occupation, history of psychiatric visits, and stress coping mechanisms were associated with mental health during the COVID-19 pandemic, but their associations with stress, severe mental distress, and anxiety symptoms differed. In addition, the actual state of mental health varied according to the respondents' occupation. It is necessary to consider the impact of the COVID-19 pandemic on mental health not only at the individual level but also at the occupational level.

Confirming validity of The Fear of COVID-19 Scale in Japanese with a nationwide large-scale sample.

Assessing fear and anxiety regarding COVID-19 viral infection is essential for investigating mental health during this epidemic. We have developed and validated a Japanese-language version of The Fear of COVID-19 Scale (FCV-19S) based on a large, nationwide residential sample (n = 6,750) recruited through news and social media responding to an online version of the questionnaire. Data was collected from August 4-25, 2020. Results correlated with K6, GAD-7 and IES-R psychological scales, and T-tests and analysis of variance identified associated factors. All indices indicated the two-factor model emotional fear reactions and symptomatic expressions of fear a better fit for our data than a single-factor model in Confirmatory Factor Analysis (χ2 = 164.16, p<0.001, CFI 0.991, TLI = 0.985, RMSEA = 0.043). Socio-demographic factors identified as disaster vulnerabilities such as female sex, sexual minority, elderly, unemployment, and present psychiatric history associated with higher scores. However, respondent or family member experience of infection risk, or work/school interference from confinement, had greatest impact. Results suggest necessity of mental health support during this pandemic similar to other disasters.

Suicide Prevention Gatekeeper Self-Efficacy Scale (GKSES).

Background: To date there is no standardized scale for the evaluation of self-efficacy of gatekeeper skills. Aim: The aim of this study was to develop the Gatekeeper Self-Efficacy Scale (GKSES), which consists of nine items assessing laypersons' confidence in their own gatekeeper skills, and to confirm its reliability and validity. Method: Altogether 875 participants joined in gatekeeper training between 2010 and 2017 and completed the GKSES both before and after training. After exploratory factor analysis, we analyzed Pearson's correlation between total GKSES scores and Attitude Toward Suicide Scale subscale scores and performed one-way analysis of variance for the score differences by demographics. Results: The GKSES is a univariate scale with good fit. Total GKSES score correlated with the appropriate attitudes for suicide prevention. Self-efficacy ratings after training improved irrespective of attribute. Participants who had had contact with suicidal individuals and those who had received previous suicide prevention training had high self-efficacy ratings, while a greater improvement was seen in the ratings of participants who had not had any previous contact or training. Limitations: It is necessary to assess the GKSES using more participants across other populations. Conclusion: The GKSES is a simple and useful measure with good internal consistency and validity for self-efficacy assessment of gatekeeper skills.

Visualizing the Process of Disaster Mental Health Services in the Joso Flood by Network Analyses of Emails.

Joso City, Ibaraki Prefecture, Japan was severely affected by flooding of the River Kinugawa in September 2015. Local psychiatric organizations immediately began providing disaster mental health services (DMHS). In post-disaster settings, DMHS involving organizational interventions by multiple regional institutions are required to support disaster victims. However, little is known about the process of coordinating multiple institutions or determining whether appropriate support has been provided. To elucidate the characteristics of communications that enable effective disaster medical team formation, we conducted network analyses of sender-recipient pairs of emails during the period of DMHS activity. The network analysis is a research method that represents various objects as a network of nodes and edges and explores their structural characteristics. We obtained 2,450 time-series emails from five core members of DMHS, including 32,865 pairs of senders and recipients. The network generated by the emails was scale-free, and its structure changed according to the phases of disaster recovery. In the ultra-acute phase, which lasted about 1 week, spreading information and recruiting people to provide disaster support was given the highest priority. In the acute phase, which lasted about 1 month, support and swift decision-making were essential for directing large numbers of staff. In the mid- to long-term phase, support for staff to share information and experience in small groups was observed. Network analyses have revealed that disaster medical teams must change their communication styles during the mission to adapt to different health needs corresponding to each post-disaster phase.

Apathy symptoms induced by low-dose venlafaxine: Two cases.

Recent guidelines regarding pharmacological interventions for major depressive disorder (MDD) recommend first using serotonin (5HT) selective reuptake inhibitors (SSRIs) or 5HT and norepinephrine (NE) reuptake inhibitors (SNRIs). Although SSRIs and SNRIs are effective and well-tolerated, apathy occurs as an adverse effect in some SSRIs-treated patients. Because apathy would be associated with the 5HT pathway, if a patient exhibits apathy symptoms under SSRIs treatment, a clinical strategy has been to change the SSRIs to treatment with an SNRIs. Here, I report two cases in which low-dose venlafaxine, an SNRIs, induced apathy symptoms.

Mental health of gatekeepers may influence their own attitudes toward suicide: A questionnaire survey from a suicide-prevention gatekeeper training program.

AIMS: We aimed to investigate the association between general mental health and attitudes toward suicide of participants in suicide-prevention gatekeeper training programs. METHODS: We conducted a number of half day training seminars within a suicide prevention program addressing gatekeepers. Participants filled in two questionnaires, one measuring general health (General Health Questionnaire, GHQ-12), and one measuring attitudes towards suicide (ATTS). RESULTS: The total sample size of participants was 230, of whom 115 completed questionnaires. There were no significant differences in demographic backgrounds between the good mental health (GHQ-12 ≤ 4) and the poor mental health (GHQ-12 ≥ 5) groups. The poor mental health group was more likely to think that people have the right to commit suicide. CONCLUSION: There was a difference in attitudes toward suicide between the good mental health and the poor mental health groups, indicating that attention should be paid to participants' mental health when conducting suicide-prevention gatekeeper training.

What kinds of factors affect the academic outcomes of university students with mental disorders? A retrospective study based on medical records.

AIMS: University students that suffer from mental disorders seem to have difficulty graduating. Therefore, we investigated risk and protective factors of dropping out with the aim of improving such students' academic outcomes. METHODS: First, we statistically compared the academic outcomes of 203 undergraduate students who received treatment in the Department of Psychiatry of the Tsukuba University Health Center to those of matched controls. Second, clinical factors of 370 mentally ill students were statistically compared between the dropout and graduate groups. RESULTS: Mentally ill students experienced significantly greater difficulties graduating. Furthermore, the ratio of females and the year of study at initial consultation were significantly lower in the dropout group. However, duration of illness, social withdrawal, temporary leaves of absence, percentage of diagnosis of F2, history of truancy, CGI-S/GI score, number of suicide attempts, visits to us, family consultations with us and grade repeating were longer or greater in the dropout group. Ultimately, the number of suicide attempts, CGI-S score, social withdrawal and leaves of absence were significantly associated with dropping out. Moreover, duration of social withdrawal and leaves of absence were significantly correlated with CGI-GI score. CONCLUSION: We found that the number of suicide attempts, CGI-S score, social withdrawal and extended enrollment were risk factors for dropping out, while the therapeutic effect seemed to be a protective factor. As risk factors involved states of social maladjustment, it is necessary not only to treat mental disorders, but also to provide assistance such as educational and individual support for daily living.

Standardization of Brief Inventory of Social Support Exchange Network (BISSEN) in Japan.

This study describes the Brief Inventory of Social Support Exchange Network (BISSEN) as a standardized brief inventory measuring various aspects of social support. We confirmed the reliability and validity for function and direction of support and standardized the BISSEN. For Sample 1, a stratified random sampling method was used to select 5200 residents in Japan. We conducted mail surveys and responses were retrieved from 2274 participants (collection rate 43.7%). Participants completed a questionnaire packet that included BISSEN, suicidal ideation, depression, support seeking, and Multidimensional Scale of Perceived Social Support (MSPSS). Sample 2 surveys for test-retest reliability were conducted on 23 residents at approximately two-week intervals. Participants were asked about gender, age, and BISSEN. First, we assessed the internal consistency, test-retest reliability, construct, convergent, and concurrent validity. McDonald's omega (.73-.92) and test-retest correlations (.78-.85) demonstrated adequate internal consistency and test-retest reliability. Depression, support seeking, and MSPSS were significantly correlated with all scores of BISSEN. The non-suicidal ideation group had significantly more support compared to the suicidal ideation group. Therefore, function and direction of support in BISSEN had sufficient reliability and validity. Next, we standardized BISSEN using Z-scores and percentile rank with respect to each 12 norm groups by age and gender.

Network analysis for motives in suicide cases: a cross-sectional study.

AIM: Suicide victims have various distresses or motives. There are few studies on how these motives toward suicide relate with each other. We used network analyses to extract the structures of correlations among the motives for suicide. METHODS: We obtained datasets of suicide victims from 2007-2009 in Japan in cooperation with Ibaraki Prefectural Police Headquarters. The data were analyzed by network centrality measures and a structural analysis by block modeling. RESULTS: Among the motives, depression and physical illness showed relatively high scores of 'degree centrality', whereas depression and unemployment showed relatively high scores of 'betweenness centrality'. Structural analysis by block modeling resulted in eight blocks. The most important block comprised eight motives, including conflict between parent and child, marital conflict, economic hardship, and overloaded with debt. CONCLUSION: Depression and physical illness were important and priority areas for completed suicides, although these two motives had different influences on suicide behaviors. Furthermore, structural analysis revealed the important role of a block, including some familial and financial motives, which induced hopelessness. Our results suggest that it might be useful to consider the common ways in which motivations for suicide are tied together when suicide intervention is launched from a social model point of view.

How perceived social support relates to suicidal ideation: a Japanese social resident survey.

BACKGROUND: The loss of social support is one of the major risk factors for suicide. However, there are few empirical studies that have examined how a person's suicide ideation relates to their social support. AIMS: To examine the relationship between social support and suicidal ideation. METHODS: Self-report questionnaires were sent to 2,200 randomly selected adults in Japan. The questionnaire inquired the participants about the severity of suicidal ideation, the details of current perceived social support and their degree of satisfaction with this social support. Social support and related indicators were compared among three groups of participants that varied in severity of suicidal ideation. RESULTS: People in the group that had suicide ideation during their lives reported receiving significantly less support from their family and had greater feelings of dissatisfaction with that support than those in the other groups. Furthermore, people who had suicide ideation during the month immediately preceding the survey reported providing less support to their family, relatives or friends, as well as receiving less support from family than other groups, and having stronger feelings of dissatisfaction with social support. CONCLUSION: Our study identified a strong relationship between the severity of suicidal ideation and perceived social support.